Exit Interview Form

EXIT INTERVIEW FORM

Name of Student

Position Title

PLNU ID Number

Supervisor Name

Department

Department Number

Date of Interview

I. WORKER TRAITS (5=excellent, 1=poor)

General Appearance

Dependability

Attitude Towards Work

Self Confidence

Ability to Work With Others

Self Starter

Enthusiasm and Interest

II. REASON FOR TERMINATION

III. WOULD YOU REHIRE THIS STUDENT?

IV. COMMENTS

THANKS FOR YOUR HELP! PLEASE RETURN TO THE STUDENT EMPLOYMENT OFFICE.

Student's Signature: _____________________________________ Date________________

Supervisor's Signature: ___________________________________Date________________

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Parent category: Business