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University Union & Student Engagement Center

Employee Exit Interview Form

Your Full Name

The information contained in the Exit Interview may be presented to the University Union Director. If you would prefer that your name be omitted from the form before it is passed along, please indicate so here:

Yes, I would like my name to be omitted from the Exit Interview Form.
No, I do not want my name to be omitted from the Exit Interview Form.

Employment Start Date (month and year)

Employment End Date

Reason for Leaving

Graduating
Transferring
Terminated
Other

Please explain your reason for leaving

Your Supervisor

Please take a few minutes to complete the following questions.

Describe your experience working for the University Union or Student Engagement Center

What have you learned and what skills have you developed during your employment? What has facilitated your learning?

List any suggestions you may have to improve the position you are leaving.

Please evaluate your relationships with fellow staff members, both student employees and full-time staff.

List any suggestions you have for improving operations, procedures or policies.

Any additional comments?

Would you like a copy of your responses sent to your direct supervisor?

Yes
No

Employee Signature

Sign Here

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