First Name (optional):
Last Name (optional):
SAP #:
Classification:
Division:	Bay-Delta Office BUSINESS SERVICES OFFICE Cers - Executive Management CVFPB Office Of The Chief Division Of Engineering Division Of Environmental Services Division Of Fiscal Services Division Of Flood Management Division Of Integ. Regional Water Mgmt. Division Of Safety Of Dams Division Of Statewide Integr. Water Mgmt Division Of Technology Services DTS OFFICE OF THE CHIEF Deputy Director - Cers Division Of Management Services Executive Division Floodsafe Env. Stewardship & Sw Res. Ofc HUMAN RESOURCES OFFICE OFFICE OF THE CHIEF OFFICE OF THE CHIEF COUNSEL Public Affairs Office State Water Project Analysis Office Swp Power & Risk Office West Branch East Branch Upper Feather River Oroville Southern Field Division San Joaquin Field Division San Luis Field Division Delta Field Division Oroville Field Division

Organization Unit:

Length of Service:	Year(s)     Month(s)
Civil Service Status:	CEA Full Time CEA Intermittent CEA Part Time Consultant Contractor Exempt Full Time Exempt Intermittent Exempt Part Time LTerm Biweekly LTerm Full Time LTerm Intermittent LTerm Part Time Perm Full Bi-Weekly Perm Full Time Perm Intermittent Perm Part Time Ret Annuit Intermit Ret Int. Bi-Weekly TAU Full Time TAU Intermittent TAU Part Time Volunteer
Work Phone:	Ext:
Home Phone:	Ext:
Email:	@water.ca.gov
Separation Date:
Type of Separation:	Involuntary Separation Lateral Transfer Leave State Service Promotion Resignation Retirement Leave of Absence – FMLA Leave of Absence – Non-Discretionary Leave of Absence – Discretionary Absence Without Leave

1) If transferring to another State department, please select:	Air Resources Board Board of Equalization CA Department of Public Health California Highway Patrol Department of Aging Department of Alcohol and Drug Programs Department of Alcoholic Beverage Control Department of Boating and Waterways Department of Child Support Services Department of Community Services and Development Department of Conservation Department of Consumer Affairs Department of Corporations Department of Corrections and Rehabilitation Department of Developmental Services Department of Education Department of Fair Employment and Housing Department of Finance Department of Financial Institutions Department of Fish and Game Department of Food and Agriculture Department of Forestry and Fire Protection Department of General Services Department of Health Care Services Department of Housing and Community Development Department of Industrial Relations Department of Justice Department of Managed Health Care Department of Mental Health Department of Motor Vehicles Department of Parks and Recreation Department of Personnel Administration Department of Pesticide Regulation Department of Real Estate Department of Rehabilitation Department of Resources Recycling and Recovery Department of Social Services Department of Toxic Substances Control Department of Transportation Department of Water Resources Employment Development Department Franchise Tax Board Public Employees Retirement System Resources Agency State Controllers Office State Personnel Board State Teachers Retirement System State Water Resources Control Board
2) If you are leaving for another employment, where are you going?	Public Agency Private Company Self-Employment/Consultant
New Employer Name:
3) If you are leaving for employment outside DWR, will you be:
Performing comparable work:	Yes    No
Making a career change:	Yes    No

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* Indicates Required Field 4) Primary reason(s) for leaving:
Personal reason(s), (Select all that apply; hold down CTRL key to multi-select):	Decline to State More Personal Time Family Circumstances (Child care/Maternity/Eldercare) Transportation Problems Parking Moving Health/Medical (self-resignation only) Education/Returning to School Conflict with Supervisor Conflict with Co-workers Incompatible Work Schedule Other *

Professional reason(s), (Select all that apply; hold down CTRL key to multi-select):

Decline to State Change in Work Conditions Quality of Management/Supervision Career Change Career Advancement Part-Time Employment Self-employment Better Opportunity to Advance Broader Range of Duties Better Training/Development Opportunities Adverse Action Other *

5) What did you like most about working for DWR, your division or organization unit? (1000 characters max)
6) What did you like least about working for DWR, your division or organization unit? (1000 characters max)
7) What could DWR, your division or organization unit have done to retain your services? (1000 characters max)
8) Would you consider working for DWR, your division, or organization unit again?	Yes    No

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How would you rate the communication in relation to your job?

How would you rate your working condition?

How would you rate your Supervisor and Manager on the following:

Supervisor

Manager

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Gender:	Male    Female
Age Group:	Under 40 40 or over
Disability:	None Mental Disability       Please Specify: Physical Disability       Please Specify:
Race/Ethnic Group:	American Indian Asian Black Filipino Hispanic Pacific Islander White    Sub-Group:
Are you aware of DWR procedures and resources available to remedy allegations of discrimination?	Yes   No
Discrimination experienced at DWR: (1000 characters max)
Any other comments or information regarding OWE: (1000 characters max)

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