Demographics

We value your opinion and confidentiality. Please take about 15 minutes to complete this exit interview survey. Your name and individual responses will not be shared with anyone outside Human Resources.

1. Your Last Name:

2. Your First Name:

3. Your Employee Identification Number:

4. Select Your Service Location: (if you would also prefer an in person exit interview with Human Resources please call the number given below for your location)

6. If you are with UC Physicians, please enter the name of your practice here:

8. The last day you are scheduled to work for UC Health:

Date
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9. Phone number where you can most likely be reached:

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