Dear GCA employee,
Thank you for assisting us by agreeing to complete the following exit interview form. Please answer each question honestly and feel free to be as open and frank as you wish. The information you provide will assist us in making Gaston Community Action, Inc. a better place to work and improved service provider.
Please note that the first four questions have an asterisk (*) next to them. These denote that an answer is required in order to complete the exit interview process. Our objective in collecting this data is to determine potential adverse impacts and or trends that may be affecting GCA employees.
Again, thank you for your cooperation.
1. Employee Information.*
Name Position Date Hire Date Termination Date
White African-American Hispanic Asian Native American
3. Gender.*
Female Male
4. Location.*
Administrative Office York Street Office Highland Head Start Rankin One Rankin Two Weldon Oaklawn G.E. Massey Mountainview Lingerfeldt Lincoln Park Deaton Cherryville Highland Charter School
5. Component. *
Head Start CSBG Administration weatherization Community & Program Development Highland Charter School
6. Please indicate why you are leaving the Agency and what conditions initiated the leave.
None
Employee Benefits
Please rate the following using this scale: 1= excellent 2= good 3= fair 4= poor
7. Salary.
Excellent Good Fair Poor
8. Insurance coverage.
9. Employee orientation.
10. Initial training.
11. Physical working conditions.
12. Ongoing training.
Policies and Procedures
13. Recruitment process.
14. Open door policy.
15. Performance review process.
16. Posting job openings.
Employee Relations
17. Keeping employees Informed.
18. Cooperation among employees.
19. Fair treatment of employees.
20. Upholding Agency values.
21. Morale in your area.
22. Morale overall.
23. Cooperation between employees and management.
24. Resources given to employees to do their Job.
25. Equipment provided to do my job properly.
26. Recognition given to employees for good work.
27. Agency concern with quality and excellent services.
28. Image of our Agency.
Relationship With Supervisor
Please rate the following using this scale: 1= always 1= usually 3= seldom 4= never
29. Supervisor resolved complaints and concerns promptly.
Always Usually Seldom Never
30. Supervisor listened to suggestions from employees.
31. Supervisor encouraged cooperation.
32. Supervisor treated me fairly.
33. Supervisor was helpful and knowledgeable.
34. Supervisor exhibited quality leadership.
36. Do you have another job?
No Yes [If yes [Go to question 36a]
36a. Please complete the following information.
New Job Title Company Name City and State New Salary
Yes No
44. Why or why not?
46. Do you think our Agency lives up to the values that have been chosen? If no, which value(s) did we not live up to?
No [Go to question 46a, b & c] Yes ( [Go to question 47)]
46a. How did we not live up to our values?
48. Do you have any further suggestion that will help us improve?