MM slash DD slash YYYY
EMPLOYMENT START DATE
EMPLOYMENT TERMINATION DATE
District of Columbia
Northern Mariana Islands
U.S. Virgin Islands
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Briefly explain your reason for leaving:
Which of the following were important in influencing your decision to resign? (More than one may apply)
Disliked job duties
Dissatisfied with pay
Dissatisfied with benefits
Conflict with co-worker(s)
No advancement opportunities
Returning to school
Care for family member
Other (specify below)
Is there pay of any kind owed to you?
If yes, please explain
Describe the aspects of your job which you enjoyed most.
Describe the parts of your job which you enjoyed least.
What employee benefit(s) did you value most?
What employee benefit(s) did you value least?
What could your supervisor have done to help you perform your job better?
What are your thoughts about the training provided to you?
What are your suggestions for improving communication within the organization?
Please let us know of any suggestions to make this a better place to work.
Knowing what you know now, if you were to apply for a job here would you want to work in the same job?
Knowing what you know now, if you were to apply for a job here would you want to work in the same department?
Knowing what you know now, if you were to apply for a job here would you want to work for the same manager/supervisor?
Please type your signature below