Exit Interview Questionnaire – Office of Diversity, Equity & Inclusion

Last Name

First Name

Middle Initial

Current Position

Department

Immediate Supervisor

Initial Employment Date

Last Day of Employment

Gender

FemaleMaleOther

2. Was there a specific event or issue that prompted your resignation?

YesNo

If yes, please briefly explain below:

3. Please rate the following regarding your current position:

	Excellent	Above Average	Average	Below Average	Very Poor
Quality of training received for your position.
Satisfaction and Enjoyment in your current position.
Working relationship with fellow employees.
Cooperation among different departments.
Opportunity for advancement and promotion.
Appreciation and recognition for achievements.
Overall workload for position.

4. Please rate the following regarding management:

	Excellent	Above Average	Average	Below Average	Very Poor
Treats staff with respect and dignity.
Values feedback and suggestions.
Adequately handles complaints and grievances.
Administers policies and practices in a consistent manner.
Encourages a cooperative atmosphere.

5. Did you encounter any problems in your current position?

YesNo

Either yes or no, how would you describe the academic or working environment at WCSU? In what ways did these environments contribute to either your satisfaction or dissatisfaction with the job? Please briefly explain:

6. Do you have any suggestions for improving WCSU? (Optional)

7. Was the Office of Human Resources helpful during your employment? (Optional)

YesNo

Either yes or no, please briefly explain:

8. In your perspective do you believe supervisors or administrators gave you an opportunity to voice any concerns?

YesNo

9. Do you feel that you were treated equally by your coworkers and supervisors in regards to race, religion, gender, etc.?

YesNo

If no, please briefly explain:

10. Did you experience and/or witness any behavior or conduct that would be considered harassment or discrimination?

YesNo

If yes, please briefly explain:

11. Based on your experience at WCSU, would you recommend this job to a friend, relative, etc. ?

YesNo

If no, please briefly explain:

12. Would you reapply if a future opportunity arose?

YesNo

Contact Information (Optional)

Email:

Phone Number:

Please add any additional comments:

Date/Time:

Thank you for participating in the Exit Interview Questionnaire and telling us about your experience at Western Connecticut State University. Good Luck in your future endeavors!

Salary	Personal
Return to School	Relocation
Military	Job Advancement
Benefits	Job Eliminated/Termination
Retirement	Academic/Work Climate
Other (please explain below)