This form is for the purpose of identifying non-faculty/non-research employees at the Gables and Rosenstiel Marine campuses that are exiting the University voluntarily. An Exit Interview Survey will be sent to the employee via email.

THIS FORM SHOULD NOT BE COMPLETED FOR EMPLOYEES THAT BELONG TO MEDICAL SCHOOL DEPARTMENTS.

Please review our privacy statement relating to information we collect, choice/opt-out, and correction/updating of personal information before proceeding.

* What campus does the employee belong to? (You must select one)
	Identifies the campus the position is associated with. This is not necessarily "where" the position is located.
	Gables Medical Rosenstiel Marine
* Employee Name (You must type in a response)
	The name of the employee that has voluntarily resigned.
* Employee C# (You must type in a response)
	The C# of the employee that has voluntarily resigned.
* Termination Date (You must type in a response)
	This is the effective date of the employee's resignation or retirement. This is generally the last day of work.
What is the personal email address (OPTIONAL) (Type in a response)
	The personal email address (non-UM email) of the employee that is separating.
* What is the Job Code (You must select at least one)
	Identifies the job code of the employee that is separating.
	Administrative/Professional (Job Code A) Clerical/Technical/Service/Nursing (Job Codes H, I, J, K, M) Faculty (B, C, G, D) Research (Job Code R)
* Type of Separation (You must select one)
	Voluntary Involuntary Retirement Layoff
Click here to view the list of Separation Codes and Types. Thank you for submitting this form. You will receive a confirmation upon submission if all required fields have been completed.