Exit Interview

Exit Interview NOTICE: Please supply the information requested below in order that we may evaluate employment process. Information obtained from you will be treated in a confidential manner and will be shared with your previous supervisor in summary form only.

SECTION I (IF YOU DO NOT WISH TO COMPLETE THIS SECTION, PLEASE COMPLETE SECTION II)

Job Title: ______________________________

Current Date: ___________________

REASON(S) FOR RESIGNATION/TRANSFER Inadequate salary/contract fee Dislike Supervisor/ Company Other employment Disliked working holidays & weekends Relocation Disliked working conditions No adjusted work schedule Health reasons Changes in personal life Family demands Career change Returned to school Advanced Opportunities Early Retirement Conflict with agency personnel Disliked leave policy Job demands/requirements Other (please specify) _______________________ What was your opinion of the following? Cooperation with supervisor Orientation to policies and procedures Adequacy of training Workload Your contract fee Physical working conditions

(Good, Fair, Poor) ______________ ______________ ______________ ______________ ______________ ______________

When you first reported to work, were you introduced to your co-workers? Were your duties and responsibilities explained clearly? Did your supervisor handle, in a manner satisfactory to you, problems which occurred in your work unit?

Yes Yes Yes

No No No

Did you always receive the help you needed in the performance of your Yes No duties? If yes, from whom? Supervisor Co-worker Others Was your immediate supervisor objective and fair in treatment of Yes No employees? If no, please explain: ___________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Were your performance ratings discussed with you? Did your performance ratings give you a good idea of how well you were performing your job duties?

Yes

No

Yes

No

Describe your work as an employee/ contractor of Jireh Counseling, Inc. (please check all that apply): Challenging Tedious Difficult Exciting Unbearable Overwhelming Boring Okay Easy Fun Interesting Other ________ Rewarding Educational What recommendations would you make for improving your work experiences with the agency? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Please make any other comments you wish about your employment with the Jireh Inc. _______ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Your Signature (optional): _________________________________Date: ____________

SECTION II (DO NOT COMPLETE THIS SECTION IF YOU HAVE COMPLETED SECTION I ABOVE)

I have been offered an opportunity to complete Section I of “Exit Interview Information” and choose not to participate. Your Signature (optional): _________________________________ Date: ________________ Please return completed form through one of the following ways: By mail: CEO By Fax: 404.761.0720 Jireh Counseling and Consulting Service, Inc. By Email: [email protected] 5538-M Old National Hwy, Suite 350. College Park GA 30349 ------------------------------------------------------------------------------------------------------------For JIREH use only Returned Property Checklist: First Aid Kit Yes No N/A Signature: ______________ ID Badge Yes No N/A Signature: ______________ Employee/Contractor Handbook Yes No N/A Signature: ____________ Other, if applicable: ___________________ Yes No N/A Signature: ______________ ___________________ Yes No N/A Signature: ______________ ___________________ Yes No N/A Signature: ______________ All Passwords were terminated

Signature: ______________