Appendix 38 EXIT INTERVIEW

Approved March 2003

STAFF NAME  _____________________________________________

DATE HIRED  _____________________________________________

DATE OF DEPARTURE  ____________________________________

LAST POSITION HELD ____________________________________

REASON FOR DEPARTURE AND ADDITIONAL COMMENTS:

1. a) Primary reason for leaving:

2. Other reasons for leaving:

2) Can you suggest any improvements to:

1. Your department?

2. Agency?

 

3) What was your best experience while you were here?

4) What was your most disagreeable experience while you were here?

5) Is there anything we could have done to have made your time at the Agency more rewarding?

ADDITIONAL COMMENTS:

INTERVIEW CONDUCTED BY:
Signature of Human Resources Administrator _____________________________

Date of Interview__________________________________________________

Signature of Staff Member When Available_______________________________

Signature of Service Director _________________________________________

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