Student Employee EXIT INTERVIEW

“DEPT NAME”

Student Employee EXIT INTERVIEW

Employee Name Employee Login

Supervisor Department

Hire Date Job Title

Exit Date

This section is to be completed by the exiting employee

1.Why are you leaving “DEPT NAME”?

Graduation (Please go to question 3)

Other (Please Specify):

2.Are there circumstances that would have prevented your departure? Yes No

If yes, please explain:

3.What did you like most about your job?

4.What did you like least about your job?

5.Was your workload usually: About Right_____ Too Heavy_____ Too light_____

6.Was the work you were performing within the duties outlined in your position description?

Yes______No______

Comments:

7. Rate your supervisor on the following points:

Almost AlwaysUsuallySometimesNever

Was consistently fair( )( )( )( )

Provided recognition( )( )( )( )

Resolved complaints( )( )( )( )

Was sensitive to employees' needs( )( )( )( )

Provided feedback on performance( )( )( )( )

Was receptive to open communication( )( )( )( )

Followed departmental policies( )( )( )( )

8.How would you rate the following?

ExcellentGoodFairPoor

Cooperation within your department( )( )( )( )

Interdepartmental cooperation( )( )( )( )

Personal job training( )( )( )( )

Equipment provided (materials, resources, facilities)( )( )( )( )

Performance Evaluations( )( )( )( )

Rate of pay for your job ( )( )( )( )

Career development/Learning opportunities( )( )( )( )

Physical working conditions( )( )( )( )

Comments:

9.Would you recommend “DEPT NAME” to a friend as a good organization to work for?

Most definitely With reservations No

10.What suggestions do you have to make “DEPT NAME” a better place to work?

11. What life skills did your employment with “DEPT NAME” increase? (Check all that apply)

Leadership Skills
Decision-Making
Communication
Verbal
Non-Verbal
Written
Training Skills
Supervisory Skills
Computer Skills / Organizational Skills
Customer Service Skills
Team Work Skills
Time Management
Creative Thinking
Critical Thinking
Assertiveness
Financial Management
Adaptability
Tolerance of Risk / Planning
Relationship Building
Initiative
Implementation
Interviewing Skills
Conflict Resolution
Tolerance for Stress
Follow Through
Other (please specify)

I have read and completed the above questions to the best of my knowledge regarding my employment with “DEPT NAME”:

Employee (Sign) Date Employee Name (Print)

IMPORTANT – MUST READ BEFORE FILLING OUT!

Directions: After the employee completes the first section of the exit interview, please answer the following questions privately; do not complete this form in front of the exiting employee. When finished, please submit the entire completed form to “DEPT NAME” Human Resources in “ROOM #”.

1) Exiting employee’s name: Login: Dept:

Last day of work: ______

2)How did your experience and interactions with this employee help you grow as a Supervisor?

3)Did the employee have attendance or insubordination issues while working for “DEPT NAME”?

Yes_____ No_____

If yes, please explain:

4)How would you rate the overall job performance of this employee?

____Poor _____Below Average _____Average _____Above Average _____Exceptional

Please explain:

Would you recommend that this employee be rehired with “DEPT NAME”?

_____ Yes _____No

Please explain your answer:

______

Supervisor Name (Sign) Date Supervisor Name (Print) Department