Exit Interview Form

OVERTON INDEPENDENT SCHOOL DISTRICT
Name*
Job Title*
Campus/Dept.*
Campus/Department*
Date Employment Started*

MonthDayYear
Date
Date Employment Ended*

MonthDayYear
Date
Street Address*
City*
State*
Zip*
Phone No.*
Email Address (for final pay stubs)*
example@example.com
Reason for Termination*

DischargeRetirementNonrenewalRIFResignationExtended DisabilityWith NoticeWithout NoticeOther
Check all applicable reasons for leaving. To be completed only by all voluntary resignations:*

Moving from districtFamily circumstancesReturning to schoolDissatisfied with type of workHealth reasonsFound a better positionOther
Comments
Where applicalble, review and discuss the following items:

Medical CareGroup Life InsuranceUnemployment InsuranceDisability InsuranceReturning District PropertyTurn in KeysTurn in BooksTurn In Name Badge / Security BadgeTurn in Parking TagPay Cafeteria Fees
Comments
QUESTIONNAIRE

How would you rate your experience in OVERTON ISD with regards to the following? Check appropriate box
Working relationship with your supervisor*

ExcellentGoodFairPoor
Cooperation within department*

ExcellentGoodFairPoor
Cooperation with other departments*

ExcellentGoodFairPoor
Adequacy of job orientation and training*

ExcellentGoodFairPoor
Workload*

ExcellentGoodFairPoor
Physical working conditions*

ExcellentGoodFairPoor
Availability of materials/equipment*

ExcellentGoodFairPoor
Evaluation procedures*

ExcellentGoodFairPoor
Recognition on the job*

ExcellentGoodFairPoor
Employee benefits*

ExcellentGoodFairPoor
Communication within the district*

ExcellentGoodFairPoor
Central administration support*

ExcellentGoodFairPoor
Community support of district*

ExcellentGoodFairPoor
Overall experience with OVERTON ISD*

ExcellentGoodFairPoor
Comments
2. What factors made your employment a positive experience with OVERTON ISD?*
3. Do you have any comments or suggestions to improve OVERTON ISD?*
4. Would you recommend OVERTON ISD to others as a place to work? YesYes, with reservation(s)No
Would you recommend OVERTON ISD to others as a place to work? YesYes, with reservation(s)No*

YesYes, but with reservationsNo
Interviewed by*
Date*

MonthDayYear
Date
Signature of Employee*

Clear
Date*

MonthDayYear
Date
Should be Empty:

QUESTIONNAIRE