Staff Exit Interview Questionnaire

We are interested in identifying opportunities to improve the work environment at St. Thomas. Please respond to each of the following questions with honesty and candor. Your feedback is greatly appreciated. Your answers will be kept confidential and used only for informational purposes. This form will not be kept in your personnel file.

1. Name (optional):

Name (optional):

2. Title:

Title:

3. Department or Academic Unit:

Department or Academic Unit:

4. Please indicate your years of service:

Please indicate your years of service: Less than 5 years

5 - 10 years

10 - 15 years

15 - 20 years

20 or more years

5. Last Day of Work:

	MM		DD		YYYY
Date	Last Day of Work: Date Month	/	Day	/	Year

6. First Day of Work/Start Date:

	MM		DD		YYYY
Date	First Day of Work/Start Date: Date Month	/	Day	/	Year

7. Job Classifications:

Job Classifications: Exempt/Salaried

Non-exempt/Hourly