Section 1 (Pacific West Regions: Exit Interview Questionnaire)

The purpose for soliciting your feedback is to better understand the specific reason(s) you are leaving the U.S. Fish and Wildlife Service. Please share your work experiences to help us make positive changes to our workplace environments. Completion of the questionnaire is voluntary, but we encourage your participation. The Exit Interview results will be presented as statistical data identifying overall themes and trends derived from the Questionnaire responses. The anonymity and confidentiality of your feedback will be carefully protected. While completion of any questionnaire item is optional, full completion of the form will best support us in improving the future of the workplace.

Thank you in advance for completing the Region 1 & 8 Exit Interview Questionnaire. The questionnaire should take approximately 5-10 minutes to complete.

* 1. Date:

Today's Date

* 2. Name of Employee:

* 3. Region No. & Name of Office or Station:

* 4. Date of Separation:

Separation Date

* 5. Job Title, Series, and Grade:

* 7. Appointment Type (Please, select all that apply):

* 8. Are you in a Fire-related position:

* 9. Self Identification (Please select all that apply):

* 10. Prior to this appointment have you ever worked for FWS?

* 11. Prior to this appointment have you ever worked for any other Federal agency?

* 12. If "Yes" to the previous question what type of appointment did you have?

Note: All temporaries, including Pathways participants, please skip Question 13 through 15, and continue to Section 2, Question 16.

* 13. My reason(s) for leaving is . . . (Please select all that apply)

* 14. If you are leaving the FWS, is there something that might have kept you from leaving?

* 15. If you are leaving the FWS, would you consider returning to work with the FWS in the future?