Commonwealth of Pennsylvania
Employee Mobility Information Program

Exit Information Survey

To be completed by permanent employees voluntarily separating from state service
in agencies under the Governorís jurisdiction.

This is not the actual form.

Thank you for your service to the Commonwealth of Pennsylvania.  It is vital for the Commonwealth as an employer to know what is important to its employees.  As a result, the following exit survey has been designed to capture your impressions about Commonwealth employment and the reasons why you are leaving. 

Please take a few moments to complete the survey.  The Commonwealth will use the information gathered from exit surveys to enhance recruitment and retention efforts.  The information contained in this survey is confidential unless the information disclosed reveals harassment or other illegal or discriminatory activity.  Reports of such activities will be provided to the proper authorities for investigation.

Part 1:  Leaving Commonwealth Employment

Please select why you are leaving the Commonwealth:
Retirement      Voluntary Resignation

Choosing from the factors listed below, please rank in order up to five factors that influenced your decision to leave Commonwealth employment, with factor #1 being the most important, factor #2 the second most important, etc.

  Reasons why you are leaving Commonwealth employment: 
   Better Salary  Pay Raises Too Low 
   Better Health Benefits  Changes to Existing Employee Benefit Programs 
   Child Care Issues Elder Care Issues 
   Personal, Health, or Family Reasons  Career Change 
   Location of Work Site  Need to Relocate Geographically 
   Lack of Parking  Lack of Transportation
   Length of Commute  Educational Pursuits 
   Lack of Promotional/Advancement Opport. Inadequate Training/Development Opportunities
   Type of and/or Lack of Work Variety Lack of Meaningful Work/Challenging Work
   Lack of Recognition for Work Talents were Not Utilized
   Lack of Feedback on Work Results/Ideas Lack of Meaningful Perf Management/Evaluations
   Ineffective Management or Supervision Conflict with Management or Supervision
   Discrimination Sexual Harassment
   Poor Communication Favoritism/Lack of Fairness
   Poor Morale Conflict with Co-workers
   Poor/Unsafe Working Conditions Unhealthy Work Environment
   Poor Safety/Security Attention Not Given to Suggestions
   Excessive Workload Not Enough Work
   Work Hours/Schedule Leave Policy
   Lack of Overtime Too Much Overtime
   Lack of Availability of Resources Staffing Challenges/Under Staffed
   Introduction of New Technology/Systems Too Much Work Related Travel
   Gain New/Expand Work Experience Pursue a Reduced Work Schedule
   Retirement Eligible
Other (Please specify)


Factor # 1 Other:


Factor # 2 Other:


Factor # 3 Other:


Factor # 4 Other:


Factor # 5 Other:

If you indicated discrimination or sexual harassment as a reason why you are choosing to leave Commonwealth employment, please identify the basis for your allegation by selecting from the following:

Religious Creed
Union Membership
Gender Identity or Expression
Disability or Perceived Disability

Sexual Orientation
National Origin

If you are leaving Commonwealth employment due to alleged discrimination or sexual harassment, you are strongly urged to report the matter to the Agency EEO Officer, Human Resource Director, or other designated official.  For further information contact the Office of Administration, Bureau of Equal Employment Opportunity at 717-783-1130.

Which of the following options best describes your plans after Commonwealth employment?

How would you rate your employment experience with the Commonwealth? 

Would you recommend the Commonwealth as an employer?
Yes     No


What would have influenced your decision to stay? 

What suggestions do you have to improve the job you are leaving?

What additional comments, suggestions, and/or recommendations do you have regarding your Commonwealth employment?


Part 2:  Re-employment

Do you wish to be considered for future employment with the Commonwealth as an annuitant?
(reinstatement or reemployment of a person retired from Commonwealth service)  Yes     No

Would you consider future employment with the Commonwealth as a reinstatement?   Yes    No