| Employment Experience |
Please rate the following on a scale of 1(poor) to 5 (excellent): |
| The overall work environment:* | 1 2 3 4 5 |
| The co-operation/friendliness of the work environment:* | 1 2 3 4 5 |
| The physical work environment:* | 1 2 3 4 5 |
| The quality of training received:* | 1 2 3 4 5 |
| Availability of resources to perform your job:* | 1 2 3 4 5 |
| The cultural sensitivity of staff and management:* | 1 2 3 4 5 |
| The quality of supervision you received:* | 1 2 3 4 5 |
| The extent of which your skills were utililized:* | 1 2 3 4 5 |
| The distribution and accountability for work assignments:* | 1 2 3 4 5 |
| Compensation & benefits:* | 1 2 3 4 5 |
Please answer the following questions: |
| Would you recommend this company as a place to work?* | Yes No |
| Is there a particular practice or working condition that led to your resignation?* | | please explain |
| What recommendation(s) would you make to help us improve? | | |
| Additional Comments: | | |
| Certification and Filing Instructions |
I certify that the information that is contained in this report is true and accurate. |
| Signature:* |
| fill in your name |
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