Code No. 401.17E2
Confidential Exit Interview Form
1. What was your opinion of: (circle one for each area)
Your pay: excellent good fair poor
Your hours: excellent good fair poor
Assigned duties & work load: excellent good fair poor
Supervision: excellent good fair poor
Working condition: excellent good fair poor
Co-workers: excellent good fair poor
Comments: ___________________________________________________________________
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2. Did you get adequate in-service training? Yes no
3. Have you obtained another position? Yes no
Does it have?
Better Pay: yes no
Shorter hours: yes no
Better opportunity: yes no
Better working environment: yes no
4. What changes about the working conditions could be made that might change your mind about leaving?
Comments : _________________________________________________________________
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5. Will you be doing:
Same kind of work?
Different kind of work?
If different work, what type of work? ________________________________
6. What specific changes would you make to your job descriptions and functions?
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7. What changes would you make in functions of staff who affected your assignment?
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8. Do you have abilities and skills that you feel were not used?_____________
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9. What changes would you suggest to improve the services of the district? _
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10. Do you feel you have been treated fairly during the duration of your employment with the district? __________________________________________________________________
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11. After you leave, what image of this district will you discuss with other people?
_____________________________________________________________________________
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12. Any comments or questions you would like to add? _______________________
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SIGNATURES:
Exiting Employee _______________________________ Date ________________
Authorized Interviewer ___________________________ Date _______________
Approved 5-20-2019 Reviewed 2-20-2023