FLORIDAA&MUNIVERSITY
EXIT SURVEY
PART A
BY EMPLOYEE
Name______Employee ID#______
Position Title ______College/School/Department______
Last Work Day______Current Bi-weekly Salary______
Future Mailing Address______Telephone Number ______
______
______
CHECK REASON FOR RESIGNATION/TERMINATION:
( ) Retirement( ) Marriage( ) Health Reasons
( ) School( ) Disability( ) Wage Dissatisfaction
( ) Work Dissatisfaction( ) Change in Residence( ) Accepted Other Employment
( ) Personal Reasons( ) Military Service( ) Laid Off (insufficient work or funds- specify below)
( ) Other –Specify below
Are you currently filing Financial Disclosure?_____Yes_____No
(If yes, please complete the Final Statement of Financial Interests Forms)
Is this termination of employment voluntary on your part?_____Yes_____No
Give complete details explaining why you are leaving employment with FloridaA&MUniversity.
______
______
______
CHECK CORRECT BLOCK
Terminating with the State of Florida?_____Yes_____No
Transferring to another State Agency?_____Yes_____No
______
Employee’s SignatureDate
Comments of Personnel Interviewer:______
______
______
Interviewer’s SignatureDate
( ) Check here if employee was unavailable for signature.
( ) Check here if employee was discharged for misconduct.
HR_TL-2(a)
FLORIDAA&MUNIVERSITY
EXIT SURVEY
PART B
By President, Vice President, Dean, Director,
Division Director or Area Chairperson (as appropriate)
______
Employee’s NameEmployee ID#
______
Last Work Day
How satisfied are you with the present job performance of this employee?
( ) Well satisfied with employee
( ) Generally satisfied with employee
( ) Somewhat disappointed with employee
( ) Very disappointed with employee
Recommended for re-employment? _____ Yes _____ No
If No, specify reasons below:______
______
______
______
Other Comments: ______
______
______
______
SignatureDate
HR_TL-2(b)
FLORIDA A&M UNIVERSITY
FACULTY/STAFF TERMINATION CLEARANCE FORM
Employee’s Name Employee ID# Termination Date
______
College/School/DepartmentSupervisor’s Name (Print)
General Instructions:
Please contact each area listed below and ask for the individual responsible for clearing a terminating employee.
CLEARED NAME OR PERSON
AREA TO CLEARYES OR NO DATE CLEARED GIVING CLEARANCE AMOUNT OWED
Administrative Parking
Telephone: 561-2205______
Fax 561-2204
Controller’s Office-Student Accounts
Telephone: 599-3137______
Fax: 599-8618
University Travel Office
Telephone: 561-2978______
Fax 561-2461
Property
Telephone: 599- 3678______
Fax: 561-2607
Purchasing Department
Telephone: 599-3203______
Fax: 561-2160
Payroll (599-3611)
Fax 412-5566______
This employee has no property entrusted to their care (Supervisor Signature is required):
Supervisor Print: ______Supervisor Signature: ______Date:______
NOTE:Each area will have seven (7) business days from receipt to process and return this form. If a response is not received withinseven (7) business days, the Office of Human Resources will consider the employee cleared from the area. Please return this form to the Office of Human Resources, 211 Foote-Hilyer Administration Center, Tallahassee, FL, 32307.
HR_TL-2(c)
Revised 1/2017