Name: 305.05 Exit Forms
Supersedes: 04/05/09; 04/18/07
The forms on the following pages must be completed before an employee leaves employment at
EMPLOYEE EXIT FORM
JOB TITLE ________ ________________________________________________
EFFECTIVE DATE OF SEPARATION ______________________________________
Due to the increasing number of records and reports that must be maintained, an employee
leaving employment with Jefferson Davis Community College must check out with the areas
listed below at the time of separation. This procedure is also intended to provide individuals
with an opportunity to discuss pertinent matters with appropriate college representatives.
The items must be completed and initialed by the appropriate individuals before reporting to
the Payroll Office. The final paycheck will not be issued until this form is completed.
AREA OF CHECK TASK INITIAL DATE
LIBRARY Turn in books
BUSINESS OFFICE Turn in keys
Verification of live work payment (if applicable)
REGISTRAR’S OFFICE Turn in grades
DIVISION CHAIR Turn in copy of exams
Turn in grade book
Turn in undistributed student papers
DEAN OF INSTRUCTION Instructional Exit Process Completed
SUPERVISOR / DIV CHAIR Verification of return of college property
PAYROLL OFFICE Turn in completed checklist
FOR INTERNAL USE ONLY
AREA OF CHECK TASK INITIAL DATE
BUSINESS OFFICE Delete from budget center
Remove copy code
Remove postage code
TECHNOLOGY Remove computer authorization
Remove telephone authorization
Update faculty/staff directory
JEFFERSON DAVIS COMMUNITY COLLEGE
EXIT INTERVIEW QUESTIONNAIRE
(Please Print) Last First M.I.
As a terminating employee of this institution, the information that you provide in this exit interview
questionnaire will prove to be a valuable source of information regarding various aspects of your
employment experience. We hope that you will be candid with your responses so that we may gain
information form your experience within the Alabama College System.
Please be assured that this questionnaire will not become part of your permanent personnel file, and our
comments will not affect the possibility of re-employment with this institution.
Gender: Male Female
White , not of Hispanic Origin Origins in any of the peoples in Europe, North Africa, or the Middle East.
Black , not of Hispanic Origin Origins in any black racial group.
Origins in any of the peoples of the Far East, SE Asia, the Indian
Asian or Pacific Islander Subcontinent or Pacific Islands.
American Indian or Alaskan Origins in any of the original peoples of North America who maintain
Native cultural identification through trial affiliation or community recognition.
Origins of Mexican, Puerto Rican, Central of South American or other
Hispanic Spanish culture regardless of race.
Number of Years in the Retirement System:
Number of Years Employed at the Institution:
1. Describe the circumstances that prompted your separation from the institution:
2. Mark any of the following that are reason(s) for your separation:
___ Job Responsibility
___ Opportunity for Advancement
___ Work Hours
___ Equipment and Supplies
___ Job Security
___ Training and Development
___ Physical Working Conditions
___ Other (please explain):_______________________________________________________
3. If you are going to a different job, what does it offer that this position did not?
Employee Signature: __________________________________________