Exit Interview Form

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Nova Southeastern University values your opinion and would like to know more about why you are leaving the university or your current position. Your individual responses are optional and treated as confidential, and will not become part of your personnel file. Responses to these questions will be used for internal improvements and shared on a limited need-to-know basis.

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Name:

Employment Date:

Job Title:

Department:

Supervisor:

Termination/Transfer Date:

Separation Type:

Other:

1. Are you transferring to another NSU department / position?

Yes No

2. Why are you leaving Nova Southeastern University or transferring from your current position? (To be completed by voluntary resignations only, please check those that MOST apply)

Other:

3. If you are leaving the university, did you explore the possibility of another position within NSU?

Yes No

Explain:

4. Do you feel you had adequate job training?

Yes No

Explain:

5. Rate NSU	Excellent	Good	Fair	Poor	Comments
a. Employee Orientation
b. NSU Benefits Package(s)
c. Performance Reviews

6. What factors made your employment a positive experience with regards to:

a. Your position?

b. Your department?

c. NSU?

Additional Comments:

7. What factors made your employment a negative experience with regards to:

a. Your position?

b. Your department?

c. NSU?

Additional Comments:

8.	Rate your Job Experience:	Always	Sometimes	Never
a.	I enjoyed my work activities
b.	I was challenged by my job
c.	My supervisor gave clear instructions for tasks / responsibilities
d.	I was recognized for my good work
e.	My job description accurately reflects my job responsibilities
f.	I was given honest, worthwhile performance appraisals
g.	My department was adequately staffed
h.	Upper management communicates well with employees
i.	I felt there were opportunities for career advancement
j.	University policies and practices were followed
k.	My workload was manageable

9.	Rate Employee Benefits:	Excellent	Good	Fair	Poor	No Opinion
a.	Tuition Waiver
b.	Health Insurance (Medical & Dental)
c.	TIAA-CREF (Retirement Plan)
d.	Vac/Sick/Personal Time Alottment

Any benefits you would like to see added?

Additional Comments:

10. If you are leaving the university, would you reapply with NSU in the future?

Yes No

11. If you are leaving the university, please rate your overall experience at NSU

12. Would you like to discuss the content of this form with a representative of Human Resources?

Yes No

If so, please provide a telephone number where you can be reached:

Thank you for your cooperation.