Your Email:
Section I (please complete fully).
The title of the job you are leaving:
Please indicate the total time you were employed with CCS: (years/months).
Please indicate the time you were in the position you are leaving (years/months).
Please check your current type of appointment. Age (optional) 17-25 26-35 36-45 46-55 56 - Older
Gender (optional) Male Female
Ethnicity (optional) White Black Hispanic American Indian Asian Multi-racial
Section II
Instructions: Please read each sentence below and choose the option that best describes your feelings. You may add additional comments in the following section. Please complete each one. My supervisor clearly explained my job assignments. Strongly agree Agree Disagree Strongly disagree No response
My supervisor was a good role model. Strongly agree Agree Disagree Strongly disagree No response
My supervisor gave me information on policies/practices. Strongly agree Agree Disagree Strongly disagree No response
The workload at my work site was distributed fairly. Strongly agree Agree Disagree Strongly disagree No response
The pay I received was fair for the work performed. Strongly agree Agree Disagree Strongly disagree No response
I received adequate training for the work I was expected to do. Strongly agree Agree Disagree Strongly disagree No response
There was good teamwork in my work area. Strongly agree Agree Disagree Strongly disagree No response
I am proud of the work I have done here. Strongly agree Agree Disagree Strongly disagree No response
I would recommend my prior CCM as a good place to work. Strongly agree Agree Disagree Strongly disagree No response
My supervisor gave me regular feedback on the work I did. Strongly agree Agree Disagree Strongly disagree No response
My unit had enough staff to get the work done. Strongly agree Agree Disagree Strongly disagree No response
I had enough materials/resources to perform my job. Strongly agree Agree Disagree Strongly disagree No response
I felt that my safety was important to management. Strongly agree Agree Disagree Strongly disagree No response
Management understands the importance of balancing personal/work issues. Strongly agree Agree Disagree Strongly disagree No response
Our consumers are treated with dignity and respect. Strongly agree Agree Disagree Strongly disagree No response
Consumers receive the best possible service from our company. Strongly agree Agree Disagree Strongly disagree No response
Career/promotional opportunities were available for interested staff. Strongly agree Agree Disagree Strongly disagree No response
The same standard of discipline was applied to all staff. Strongly agree Agree Disagree Strongly disagree No response
My supervisor and I discussed my work plan so I wold understand what was expected of me. Strongly agree Agree Disagree Strongly disagree No response
I would apply to work again for CCM. Strongly agree Agree Disagree Strongly disagree No response
Section III
1) What was the most important reason that led you to begin seeking other employment? Choose one (Note: this may be different from the reason you decided to leave which will be captured in the next question. Insufficient training/orientation Career advancement opportunities Job not a good fit Quality of consumer/program services Work conditions Quality of supervision Work/life balance issues Lack of recognition Company culture Job duties misrepresented Better pay Pay inequities among peers Pay not equivalent to job duties Other:
Other (please explain):
Work environment (please explain):
2) Please check all the reasons you are leaving CCM. From your answers in #2 above please indicate your main reason for leaving:
Section IV
Please indicate the type of job or occupational field you are taking or seeking (if applicable):
Please indicate the type of job or occupational field you are taking or seeking (if applicable): Clerical and office work Accounting Legal or administrative management Information technology Education Other human services Medical or other health-related jobs Institutional services Public safety Corrections Agriculture Manufacturing Food service Engineering or transportation Skilled trade Other:
Other:
Please state what if anything would have helped you to continue your employment with CCM:
I would like to recommend the following suggestions to my prior management.
Do not enter anything in this field:
