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STRICTLY CONFIDENTIAL ** STRICTLY CONFIDENTIAL ** STRICTLY CONFIDENTIAL

Instructions. To be completed a minimum of one week prior to the employees separation date

from CARE International in Indonesia. On completion, please submit this uestionnaire to the

!R "ana#er, Aceh in a sealed en$elope marked Confidential. The information pro$ided will

assist the !R %nit to assess staff turno$er. All information will be treated as strictly confidential.

E"&'O(EE )ETAI'* +optional

-ame Zulham Efendi

&osition Data Entry

'ocation Banda Aceh

&roect/)ept. ealth De!artment

*uper$isor Sahran Syu"ur

*tart )ate #anuay $%& '(()

*eparation )ate Se!temer $& '(()

Contract Type Re+ular

)id you recei$e a

CARE briefin#0

yes no

C%RRE-T &O*ITIO-

Interest 'e$el of 1ork e2cellent #ood a$era#e unsatisfactory

%se of your skills e2cellent #ood a$era#e unsatisfactory

Responsibility e2cellent #ood a$era#e unsatisfactory

Autonomy e2cellent #ood a$era#e unsatisfactory

1ork load e2cellent #ood a$era#e unsatisfactory

3uality of super$ision e2cellent #ood a$era#e unsatisfactory

*upport from

"ana#ement

e2cellent #ood a$era#e unsatisfactory

Comments +optional

I-TER-A' RE'ATIO-*!I&*

Relationship with peers e2cellent #ood a$era#e unsatisfactory

Relationship with

mana#er/head

e2cellent #ood a$era#e unsatisfactory

CARE INTERNATIONAL in INDONESIA

Banda Aceh

E,IT -.ESTIONNAIRE f/r E0itin+ Staff

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Accessibility of

mana#er/head

e2cellent #ood a$era#e unsatisfactory

4eedback on

performance

e2cellent #ood a$era#e unsatisfactory

Teamwork e2cellent #ood a$era#e unsatisfactory

Communication withinproect/dept

e2cellent #ood a$era#e unsatisfactory

Communication within

5akarta Office

e2cellent #ood a$era#e unsatisfactory

"orale of staff e2cellent #ood a$era#e unsatisfactory

Comments +optional

'I-E "A-A6E"E-TE2plained your ob

tasks properly

always usually seldom ne$er

*howed fair treatment always usually seldom ne$er

6a$e praise for #ood

performance

always usually seldom ne$er

6a$e help when

needed0

always usually seldom ne$er

Informed you as to

your pro#ress0

always usually seldom ne$er

'istened to

su##estions/ criticisms0

always usually seldom ne$er

)ealt promptly with

problems0

always usually seldom ne$er

Comments +optional

1OR7I-6 E-8IRO-"E-T

1ork location e2cellent #ood a$era#e unsatisfactory

1ork area e2cellent #ood a$era#e unsatisfactory

3uality of euipment e2cellent #ood a$era#e unsatisfactory

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A$ailability of

euipment

e2cellent #ood a$era#e unsatisfactory

Comments +optional

RE"%-ERATIO- A-) 9E-E4IT*

"onthly salary e2cellent #ood a$era#e unsatisfactory

!olidays e2cellent #ood a$era#e unsatisfactory

R:R policy e2cellent #ood a$era#e unsatisfactory

Other benefits e2cellent #ood a$era#e unsatisfactory

Comments +optional

REA*O- 4OR 'EA8I-6 +please tick as applicable

End of proect/contract

4undin# no lon#er a$ailable

!i#her salary

9etter remuneration and benefits packa#e

9etter trainin# opportunities

9etter career prospects

4amily obli#ations

Impro$ed status

"edical reasons

1orkin# en$ironment

Other Reason +please state;

1hat is your o$erall $iew of CARE as an employer0

CARE one of big NGO, which have quite a lot assisting human is befalled bydisaster. therefore CARE shall nor forget to be more give attention for roserity ofofficer fairly and wise

1hat would ha$e pre$ented you from lea$in# CARE0

If my contract continue

!i#hli#hts of your time with CARE in Aceh

I am #ettin# many e2perience and also new science durin# workin# in CARE as well as

#ettin# many new friends.

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4inal Comments

I am $ery #lad can be workin# with CARE and I hope CARE to be #ood -6O in future

I declare that the information #i$en in this uestionnaire is correct

Employee *i#nature;