Employee Exit Interview Report (Form 877)

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First Name (optional):
Last Name (optional):
SAP #:
Length of Service: Year(s)     Month(s)
Civil Service Status:
Work Phone:   Ext:
Home Phone:   Ext:
Separation Date:
Type of Separation:
1) If transferring to another State department, please select:
2) If you are leaving for another employment, where are you going?
New Employer Name:
3) If you are leaving for employment outside DWR, will you be:  
Performing comparable work:   
Making a career change:   

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