Employee Exit Interview Report (Form 877)

Page 1 of 4 Page 2 of 4 Page 3 of 4 Page 4 of 4
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:
I choose to waive my anonymity:   
  Selecting 'yes' authorizes OWE to share your name with the hiring authority. Selecting 'no' means that OWE will not share your name with anyone.
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:   

DWR Home | Conditions of Use | Privacy Policy
Copyright © 2016 State of California