Exit Interview

Name

First Name

Last Name

Department

Hire Date

YYYY

Supervisor/Manager

Job Title

Resignation Date

YYYY

Do we have permission to share your feedback with Management?

What are your primary reasons for separating from Wilson County?

Is your management aware of the reasons for your separation?

If you are leaving for other employment, where is your new job?

What is your new position (job title)?

Where is your new rate of pay in relation to what you were paid with Wilson County?

Lower

Equal To

Higher

What prompted you to seek other employment?

What qualifications or skills do you have that were not utilized in your job?

Please indicate how you feel about the following topics:

Wilson County Management in General:

Department Management:

Immediate Supervisor's Skills

Demonstrated Fair and Equal Treatment:

Provided recognition on the job:

Developed cooperation and teamwork:

Encouraged and listened to suggestions:

Resolved complaints and problems:

Showed professionalism:

Offered feedback on performance:

Overall rating for Immediate Supervisor:

Please indicate how you feel about the following topics:

County Services and Programs:

Work Relations with Co-Workers:

Wilson County as a Place to Work:

Salary:

Benefits:

Health Coverage:

Dental Coverage:

Life Insurance:

Disability Insurance:

Educational Assistance:

Opportunity for Growth and Advancement:

Training:

Job Responsibilities:

Working Conditions:

Cooperation within your Department:

Cooperation between Departments:

Workload Stress:

Job Security:

Safety:

Equal Opportunity / Affirmative Action:

Overall Morale:

Additional Comments

What changes would you make for improvement?

If Wilson County could do one thing to make you stay, what would it be?

Please provide your forwarding address below:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country