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Separation of Employment Review

Information shared within the form below is completely confidential. It will purely be used as a tool to gain candid information on employment conditions within the College. The information will not become part of your permanent record. As this information is useful in making improvements at the College, we encourage you to be as direct and honest about your experience as possible.

Employee/Position Information
Employee First Name:
Last Name:
Position Title:
Supervisor Last Name:
Employment Type:
Last Day of Employment: clear

Separation Questions
1.) Describe briefly the job you performed at the College:

2.) What is your main reason for separation of employment?
(check one)
Use this space to describe any related circumstances:

3.) Did you attempt to seek alternative employment at Palm Beach State College?
If Yes, the position of interest was:
4.) Did you enjoy working at the College?
Please tell us what you liked and didn't like.

5) What did you think of your direct supervisor in regard to the following?

Always Sometimes Never
A. Demonstrated fair and equal treatment
B. Provided recognition on the job
C. Developed cooperation and teamwork
D. Encouraged/listened to suggestions
E. Followed policies and procedures
F. Communicated needed information
G. Resolved complaints and problems
H. Supported work-life balance
Please provide comments, especially for any of the above marked either Sometimes or Never:

6) What did you think of the following in relationship to your job?

Excellent Good Fair Poor
A. Cooperation / Teamwork in your department
B. Department orientation and on-the-job training
C. Communication within the department
D. Communication college-wide
E. Work schedule
F. Workload
G. Potential for career growth
H. Department morale
Please provide comments, especially for any of the above marked either Fair or Poor:

7) How did you feel about the salary and benefits provided?

Does Not Apply Excellent Good Fair Poor
A. Base Salary
B. Retirement Plan
C. Medical Insurance
D. Dental Insurance
E. Optional Life Insurance
F. Disability Insurance
G. Sick Leave
H. Vacation Leave
I. Holidays
J. Tuition Waiver
K. Wellness Programs
L. Other
Please provide comments regarding benefits, especially for any of the above marked either Fair or Poor:

8.) Are there any other benefits you feel should have been offered?
If Yes, what other benefits should have been offered?

9.) What was the greatest challenge you faced in your position?

10.) What does your new job offer that your job at the College did not?

11.) Would you reconsider employment with the College at a future date?
12.) Is there anything the College could have done differently that may have affected your decision to leave?
If Yes, what could have been done?

Thank you for completing the Separation of Employment Review form. Please provide any final suggestions or recommendations you may have to improve College practices, procedures and/or benefits.

Palm Beach State College