SOUTH DAKOTA BOARD OF REGENTS
EXIT INTERVIEW
Name of employee:Department:
Position Held:
Last Day of Work
1. Reason for leaving this position:
a. Resignation
b. Transfer (if transferring to another state agency)
c. Layoff
d. Retirement
- Dismissal (if dismissal or lay off, skip to #6)
- Other: ______
2. What advantages are there in working for state government?
a. Salary
b. Job security
c. Training opportunities
d. Consistent employment policies
e. Regular working hours
f. Job satisfaction
g. Good supervisors
h. Fringe benefits
i. Pleasant work environment
j. Other – please specify
3. What influenced your decision to leave? (choose as many as fit)
What was the primary reason?
a. Career opportunity
b. Working conditions
c. Too many hours
d. Too few hours
e. Content of work
f. Military service
g. Return to school
h. Child care responsibilities
i. Inadequate supervision
j. Poor management practices
k. Night or evening shift
l. Irregular work schedule
m. Salary
n. Fringe benefit package
o. Personality conflict with co-workers
p. Personality conflict with supervisor
q. Health
r. Lack of promotional opportunity
s. Moving from area
t. Other – please specify
4. If you are leaving to accept another job, is the job with:
a. Private sector
b. Public sector
c. Another position within state government.
5. You may choose how your remaining annual leave will be paid if you resign. If you are laid off or terminated for cause, you must take your annual leave in a lump sum.
a. I wish to be paid for the balance of my annual leave in one lump sum payment, to be included in my last check.
b. I wish to remain on the payroll for the duration of my annual leave.
6. Address for final paycheck and W2:
Last working day: ______
If you are currently on direct deposit, do you want your last check to be automatically deposited? __ continue to direct deposit all pay checks.______
If you are transferring to another state agency, vacation and sick leave balances will be transferred.
Agency with whom the personnel office should correspond: ___
7. To the following statements, please respond by answering AGREE, UNSURE, or DISAGREE:
a. / My duties and responsibilities were clearly explained to me when I was employed.b. / My salary was fair considering my duties and responsibilities.
c. / There were sufficient training opportunities to help me perform my duties.
d. / I felt I was doing something worthwhile in my job.
e. / The employees in my work area worked together as a team.
f. / My supervisor asked me for my ideas and suggestions.
g. / My supervisor gave me adequate job direction and feedback on my performance.
8. The things I liked best about working for my department/the state were:
9. The things I liked least about working for my department/the state were:
10. Please comment on the benefits available to state employees. Which are most important? Which are least important? Are there benefits that need review or adjustment?
- Additional comments:
Employee Signature / Date
Personnel Use Only / HRM/PA initials
Annual Leave: / Longevity Pay:
Lump sum with final paycheck;
$______for ____ hours. / Lump sum with final pay check;
$______
Remain on payroll for duration:
Last day on payroll: ______/ Ineligible for payment
Ineligible for payment: ______/ Transfer:
Sick Leave: / Vacation leave _____ hours
Lump sum with final pay check:
$______for _____ hours / Sick leave _____ hours
Ineligible for payment ______/ Date final check mailed:
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