Form 0 OPM Employee Exit Survey

OMB Approved:

            No. 3206-0236

EXIT SURVEY

Public Burden Statement:

We estimate this form takes an average of 15 minutes to complete including the time for getting the needed data and reviewing both the instructions and completed form. Send comments regarding our estimate or any other aspect of this form, including suggestions for reducing completion time, to the Office of Personnel Management (OPM), Assessment Services, Steve Burnkrant (3206-0236), Washington, DC 20415-7900. The OMB Number, 3206-0236, is currently valid. OPM may not collect this information, and you are not required to respond, unless this number is displayed.

PART I – Reasons for Leaving

1. Which of the following statements best describes the type of separation from your organization?

O	I resigned to leave the Federal government
O	I transferred within my agency
O	I transferred to another Federal agency
O	I retired due to disability
O	I retired voluntarily
O	I left involuntarily, due to a RIF
O	I left involuntarily, due to termination
O	I left involuntarily, due to contracting out
O	Other, please specify ____________________________________________

Were you asked or encouraged to leave your job? [If marked a, b, or c in item 1]

O	No, I left for my own reasons
O	Yes, because of poor performance or a personal conflict
O	Yes, because I was encouraged to pursue an opportunity elsewhere

Would you have continued working if your job or working conditions had been better? [If marked e in item 1]

O	No, I was ready to retire
O	Yes, I wanted to keep working but I was too dissatisfied
O	Not applicable, my retirement was mandatory

For the following items, indicate how important each of the following reasons was in your decision to leave your organization. If an item does not apply, mark “Not Important.”

	Not Important	Somewhat important	Very important
Personal Reasons
I wanted to change careers	O	O	O
I wanted to run my own business/become an independent consultant	O	O	O
I wanted to further my education	O	O	O
I wanted to pursue non-work interests	O	O	O
I needed to care for another individual	O	O	O
Personal health	O	O	O
Relocate due to transfer of spouse/partner	O	O	O
Relocate for other reasons	O	O	O
Get a job closer to home	O	O	O
Conflict between this job and another	O	O	O
	Not Important	Somewhat important	Very important
The Work
Too much work	O	O	O
Unsatisfactory working hours/shifts	O	O	O
Too much job stress	O	O	O
The work was not meaningful to me	O	O	O
My job did not make good use of my skills and abilities	O	O	O
Lack of receptiveness to creativity and innovation	O	O	O
Opportunities
Insufficient opportunity to make a difference	O	O	O
Lack of opportunity to participate in decision-making	O	O	O
Lack of training and career development	O	O	O
Limited opportunities for advancement	O	O	O
Lack of coaching and feedback	O	O	O
Pay and Benefits
Insufficient pay	O	O	O
Unsatisfactory benefits	O	O	O
Insufficient support for continuing education	O	O	O
Lack of support for my family/personal life responsibilities	O	O	O
Lack of flexible work arrangements/telework	O	O	O
Treatment
Lack of support for diversity	O	O	O
Unfair treatment	O	O	O
Discrimination based on race, ethnic origin, gender, age, disability, or other factors	O	O	O
Unfair performance appraisal	O	O	O
Lack of recognition for my work	O	O	O
The People
Poor working relationship with my coworker(s)	O	O	O
If you were a supervisor: Poor working relationship with my subordinates	O	O	O
Poor working relationship with my supervisor	O	O	O
Lack of trust and confidence in senior leaders (i.e., those above your former supervisor)	O	O	O
	Not Important	Somewhat important	Very important
The Organization
Too much red tape	O	O	O
Concerns about ethical issues	O	O	O
Organization was becoming too political	O	O	O
Disagreement with the organization’s goals and objectives	O	O	O
Poor physical working conditions	O	O	O
Insufficient communication about issues related to my work	O	O	O

43. Overall, how satisfied were you with your job at the time of your exit?

O	Very Dissatisfied
O	Dissatisfied
O	Neither Satisfied nor Dissatisfied
O	Satisfied
O	Very Satisfied

44. If possible, would you work for ^Agency^ again?

O	No
O	Maybe
O	Yes

45. Please describe your most important reason(s) for leaving.

46. Please describe what [Agency] could have done to keep you from leaving.

PART II – BACKGROUND AND EMPLOYMENT INFORMATION

47. Did management try to keep you from leaving your organization?

O	No
O	Yes

48. Where did you work at ^Agency^?

O	Organization A
O	Organization B
O	Organization C
O	Organization D
O	Organization E
O	Organization F

49. What performance rating (or equivalent) did you receive on your last performance appraisal?

O	Outstanding
O	Exceeds fully successful
O	Fully successful
O	Minimally successful
O	Unacceptable
O	Did not receive a performance rating
O	Don’t know

50. How long had you worked for ^Agency^?

O	Less than 1 year
O	1 to 3 years
O	4 to 5 years
O	6 to 10 years
O	11 to 15 years
O	16 to 20 years
O	21 to 25 years
O	More than 25 years

51. How long have you been with the Federal Government (excluding military service)?

O	Less than 1 year
O	1 to 3 years
O	4 to 5 years
O	6 to 10 years
O	11 to 15 years
O	16 to 20 years
O	21 to 25 years
O	More than 25 years

52. What was your pay grade or equivalent GS-level? (WILL BE CUSTOMIZED FOR AGENCY)

	Civilian
O	GS 1 – 8
O	GS 9 – 12
O	GS 13 – 14
O	GS 15 – SES
O	WG/WL/WS 1 – 5
O	WG/WL/WS 6 – 10
O	WG/WL/WS 11 or higher
	Military
O	E-1 – E-4
O	E-5 – E-9
O	W-1 – W-4
O	O-1 – O-3
O	O-4 – O-5
O	O-6 or higher

53. What was your job category? (WILL BE CUSTOMIZED FOR AGENCY)

O	Professional (for example, scientist, engineer, attorney, etc.)
O	Administrative (for example, personnel management, budget, contracting, or procurement specialist, etc.)
O	Technician
O	Clerical (for example, support staff, executive secretary, etc.)
O	Wage Grade
O	Other

54. What was your level of supervisory responsibility?

O	Non-Supervisor
O	Team Leader
O	First-Line Supervisor
O	Manager
O	Executive

55. What is the highest level of education that you have completed?

O	Less than high school graduate
O	High school diploma or GED
O	Technical, vocational, or business school
O	2-year associate degree
O	Bachelor's degree (B.A., B.S., or other)
O	Master's degree
O	Doctorate degree (Ph.D., M.D., Ed.D., J.D., etc.)
O	Post-doctoral study

56. What is your age?

O	Less than 20
O	20 – 29
O	30 – 39
O	40 – 49
O	50 – 55
O	56 – 60
O	Over 60

57. Are you male or female?

O	Male
O	Female

58. How would you describe your racial or ethnic background? (Select one or more)

O	White (Non-Hispanic)
O	Black (Non-Hispanic)
O	American Indian or Alaska Native
O	Asian or Pacific Islander
O	Hispanic or Latino
O	Other

Center for Talent Services, U.S. Office of Personnel Management 7