AMS Exit Interview

AMS Exit Interview
Please take a moment to complete the following questionnaire. We regret losing a Cleaning Professional and hope through this questionnaire we can identify problem areas and fix situations for others. This form will NOT become a part of your personnel file, and will NOT affect your rehire status. Your honest answers are greatly appreciated!
Cleaning Pro Name

First NameLast Name
Date of Exit Interview*

MonthDayYear
Employment Start Date

MonthDayYear
Date
Employment End Date

MonthDayYear
Date
Reasons for Leaving

Accepted another positionReturn to schoolChild careWorking conditionsSupervisionOpportunity for advancementRelocationDissatisfied with workPay/benefitsToo demanding/stressfulMedical reasonType of workHoursOther
If you're leaving for a new position, what makes it more attractive than the job you're leaving?

Pay/benefitsHoursFexibilityOpportunity for advancementLocationWorking conditionsResponsibilityOther

How would you rate the following?

	Excellent	Good	Fair	Poor	Comments
Wages
Satisfaction with the type of work
Workload
Recognition for a job well done
Hours
Training received
Company policies
Relationship with coworkers
Relationship with supervisor
Evaluations
Overall satisfaction

Did your Supervisor:

	Yes	No
Demonstrate fair and equal treatment?
Provide recognition on the job ?
Keep you well informed?
Be available for discussion of problems/potential problems?
Encourage feedback and feedforward?
Explain the duties and responsibilities of your job?

What is your opinion of the job you had with us?
What were some of the frustrations you experienced in the performance and execution of job responsibilities?
Would you be willing to stay with us under more stisfactory conditions?

YesNo
What would need to change in order for you to stay with us?
Have you had any work-related injuries while employed by AMS?

YesNo
If yes, when did the injury occur?
If yes, what type of injury did you sustain?
Are you being treated by a doctor for any work injuries?

YesNo
Have you had any job injuries that you haven't reported?

YesNo
If yes, when?
Do you plan to see a doctor for this injury?

YesNo
Overall Comments:
Signature

Clear
Date

MonthDayYear
Date
Should be Empty: