This site uses cookies. By continuing to browse the site you are agreeing to our use of cookies. Find out more here. Hide this message

Work with us

Leaver's questionnaire

The information submitted on this form is strictly confidential.

Section 1. Personal Details

Full name (optional)

Job title




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


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?

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?*

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

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

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)




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?

Overall, did you enjoy working for the Trust?*

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'

Section 5. Further comments

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

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?*

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

Email 2*:

* required fields




A-Z of Services

Chinese Poland

View all languages >

Coronavirus - useful information

The latest health information about Coronavirus can be found at

Information and updates about our services can be found on this website here.

As of Wednesday 21 October, after reviewing the guidance for visiting as set out by NHSE, the Trust has taken the difficult decision to suspend visiting to all of our sites, with immediate effect.  We have taken this decision to limit the spread of Covid-19, and to protect vulnerable patients and ensure staff safety.  As soon as it possible to safely relax the visiting restrictions we will do so

From Monday 15 June 2020, visitors and outpatients coming into our hospitals will be asked to wear a face covering at all times, to help us reduce the spread of Covid-19.  A face covering can be as simple as a scarf or bandana that ties behind the head.  It should cover your mouth and nose while allowing you to breathe comfortably.  For more information click here