Employee Exit Interview Questionnaire Page 2

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Dates of Employment From_________________ To ___________________
Year Participant Left Program
1
2
3
4
5
SPECIFIC REASONS, OTHER THAN ABOVE, WHICH CAUSED
YOU TO LEAVE _________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
********************************************************************
For In-House Use Only :
Sex : M
F
Veteran : Vietnam Era
Other Veteran
Non- Veteran
Ethnic : White
Disabled : Yes
Black
No
Hispanic
Am. Indian or Alaskan Native
Asian or Pacific Islander
Highest Schooling Completed :
Other
12
GED
College 13, 14, 15, 16

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