EmailMeForm
Notice of Voluntary Resignation (Confidential)
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Today's Date
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Your Name
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Your email
What is your Date of birth
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I hereby
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Voluntarily resign from my employment with Home Instead Senior Care
My last day of employment was/is
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My reason(s) for leaving include (choose as many as apply)
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(*) I didn't get enough hours
(*) I do not want to receive the COVID vaccination as is required by NYS law for all home care workers by Oct 7, 2021
(*) Relocation outside of the NYC area
(*) I didn't like the cases that I was assigned to
(*) I didn't like the way I was treated by the client
(*) I didn't like the way I was treated by the agency/ office staff
(*) Poor salary
(*) Poor support from the agency when I needed help
(*) The agency is too strict for me
(*) I am resigning pursuant to an arrangement whereby I will work privately with a non Home Instead client and by resigning pursuant to such arrangement, I will not be in violation of my non-solicitation covenant and am welcome to re-apply to HISC.
(*) Other (please explain)
I hereby represent
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I am not working (nor plan to work with) any Home Instead client privately as agreed to in my pre-employment legal documentation. I realize that doing so would result in legal action as per the agreement I signed prior to my employment
Excellent
Good
Fair
Low
I felt that the salary was
I felt that the amount of hours I received was
Professional, respectful, kind and helpful
Professional and nice
Average
Mixed reviews, depends on who I dealt with
Unprofessional
I felt that the administrative staff with me was
Please share with us 3 ways we could support our employees better
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Please share with us 3 things you appreciated about working for us
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How well do you think the agency supported you with your work related needs (client issues, etc)
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OVERALL EXPERIENCE - please rate it from 1 (lowest) to 5 (highest) and please be honest
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Would you be interested in reapplying to Home Instead in the future?
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Yes, I would consider reapplying
No, I will not be reapplying
Unknown / Not sure
Notes
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Thank you!
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for working for us and for your feedback!
Signature
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Clear
Sign your name with mouse or with your finger
Any questions? Call us at 212-614-8057 or email us at
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