Human Resources
Exit Questionnaire

General Information
1. Length of Service:
2. Salary Range:
3. Education Level:
4. Object Code:
5. Are you a Supervisor?
6. School or Division:
Questions 7,8 and 9 are optional but encouraged as the data allows us to analyze employee satisfaction demographically.
7. Race:
Are you Hispanic or Latino? Black or African American Native American or Alaskan Native Native Hawaiian or Other Pacific Islander White Asian
8. Age:
9. Gender:
Industry shift* If yes, what industry did you come from?

What were realized:
What were not realized:
Please explain:
Industry shift* If yes, what industry are you joining?

Please explain:
If no, why not?
If yes, you must provide the following information:
Last Name:
First Name:
Email Address:
Last Day of Work:
With whom do you wish to meet? (A copy of this Exit Questionnaire will be sent to the University Officer you select)
Central Human Resources
Human Resources Officer (Please select your Human Resources Officer)