County of Berks Exit Interview

Employee Information

14% of survey complete.

Please fill out the questions below pertaining to your employee information.

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1. Name (Optional)

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2. Gender (Required.)

Male

Female

Other

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3. Department (Required.)

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4. Position/Job Title (Required.)

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5. Type of Position (Required.)

Full Time

Part Time

Seasonal

Intern

Other (please specify)

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6. Union/Association (Required.)

AFSCME

Deputy Sheriffs

Detectives

Elected

SEIU

Management Confidential

Non-Union

PSSU

Teamsters

UFCW

Other (please specify)

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7. Supervisor's Name (Optional)

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8. Hire Date (Required.)

Date / Time

Date

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9. Separation Date (Last Working Day) (Required.)

Date / Time

Date

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10. Salary/Pay (Annually OR Per Hour)

Annually

Per Hour

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* 1. Name (Optional)

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* 2. Gender (Required.)

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* 3. Department (Required.)

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* 4. Position/Job Title (Required.)

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* 5. Type of Position (Required.)

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* 6. Union/Association (Required.)

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* 7. Supervisor's Name (Optional)

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* 8. Hire Date (Required.)

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* 9. Separation Date (Last Working Day) (Required.)

Question Title

* 10. Salary/Pay (Annually OR Per Hour)

1. Name (Optional)

2. Gender (Required.)

3. Department (Required.)

4. Position/Job Title (Required.)

5. Type of Position (Required.)

6. Union/Association (Required.)

7. Supervisor's Name (Optional)

8. Hire Date (Required.)

9. Separation Date (Last Working Day) (Required.)

10. Salary/Pay (Annually OR Per Hour)