Leaver's questionnaire

The information submitted on this form is strictly confidential.

Section 1. Personal Details

Full name (optional)

Job title

Band

Directorate*

Section/Ward

Line Manager

Date of leaving (dd/mm/yyyy)*

Length of service in final post

Overall length of service

Section 2. Reason for leaving

What is the main reason for leaving

PromotionBetter Terms and ConditionsHigher salaryBetter staff benefits and rewards packageBetter working conditions/flexible workingBetter prospects for career progressionPoor working relationshipsNearer homePersonal/domestic reasonsFurther educationTemporary employment endedHealth reasonsDid not return from maternity leaveRetirementRedundancyOther or more than one (please specify below)

Other

If you are going to a new job can you provide more detail on the reason given above?

If your new job has better benefits and we provided comparable benefits would this have encouraged you to stay with the Trust?

YesNo

Section 3. Overall job satisfaction

The following questions relate solely to your experience in your most recent job

What aspects of the job were most rewarding and why? (e.g. colleagues, environment, patient contact)

What aspects of the job were least rewarding and why?

Are there any aspects of this job which you would change to enable your role to be more effective? (Please identify why)

Did you feel supported in your role? (Please expand on your answer)

Overall, did you enjoy your job?*

YesNo

How would you describe your working relationship with your manager?*

Very goodGoodAveragePoor

How would you describe your working relationships with your colleagues?*

Very goodGoodAveragePoor

Please use this space to expand on the previous two questions if needed

Are there any changes you could suggest that would benefit the above working relationships?

Considering overall satisfaction with any job, what in your opinion are the three most important issues? (Please list in priority order)

1.

2.

3.

Section 4. Employment with the Trust

The following questions relate to your overall experiences and opinions of the Trust as an employer

What were the positive aspects of your employment with the Trust?

What were the negative aspects of your employment with the Trust?

What could have been done to improve your experience of working for the Trust:

By your colleagues?

By your line manager?

By your director, head of service or senior manager?

By the Trust?

What did you think of the staff benefits offered by the Trust?

Very goodGoodAveragePoor

Overall, did you enjoy working for the Trust?*

YesNo

Would you consider re-employment with the Trust in the future? (Please select the likelihood with 0 being 'very unlikely' and 10 being 'very likely'

109876543210

Section 5. Further comments

Would you like to discuss your answers personally with a representative from the Human Resources department?*

YesNo

If yes, please provide a phone number or email address we can contact you on

May we share the information on this questionnaire with your line manager?*

YesNo

Please add any further comments which have not been covered in this questionnaire