Code No. 401.17E1
Consent Form for Confidential Exit Interview
The school district encourages employees who leave employment with the district to participate in an Exit Interview.
The purpose of the Exit Interview is to provide the district the opportunity to benefit from the employee's observations on conditions of employment while with the district. The administration and the Board of Education will consider this information in its efforts to improve the district. The employee who agrees to an Exit Interview will be asked to answer questions listed on the attached Exit Interview Form. The interview will be conducted by the superintendent unless the employee designates another member(s) of the administrative team or member(s) of the Board of Education.
By signing this form the employee authorizes any information provided to be used in total or summary by the district. The employee may request that her/his name and/or position be deleted from the information as it is used by the district to evaluate employment conditions. The employee should designate the persons who will receive copies of this Exit Interview and if she/he wishes to have a copy placed in his/her personnel file.
The employee may selectively choose not to comment on questions within the Exit Interview.
EXITING EMPLOYEE AUTHORIZATION:
1. I agree to have ___________________________ conduct the Exit Interview.
2. I (do) (do not) wish to have a member of the Board of Education present at the Exit Interview.
3. I agree to have copies of my Exit Interview given to ________________________________________________
4. I (do) (do not) wish to have a copy of my Exit Interview placed in my personnel file.
5. I (do) (do not) wish to have my name or position noted on my Exit Interview form.
6. I (do) (do not) wish to have a copy of my Exit Interview Form.
7. I (do) (do not) wish to have a follow-up letter from the Exit Interview.
Exiting Employee's Signature ________________________________________
Date ________________________________
Approved 5-20-2019 Reviewed 2-20-2023