NEVADA DEPARTMENT OF CORRECTIONS

The Department of Corrections is very interested in the reasons people leave its employ. In order to assist the Department to improve its personnel management, we would appreciate your assistance in completing this form.

This form and all items therein will be held in strict confidence. While this information would be of great assistance to us, you are under no obligation to fill this out.

Present Date: _________________________________

Position Held: __________________________________________ Resignation Date: ____________________

Division/Institution: ______________________________________ Budget Acct. #: ______________________

Please indicate your reason(s) for resignation from the Nevada Department of Corrections. Check all items that may apply.

ÿ Promotion ÿ Marriage

ÿ Career Change ÿ Enter Military

ÿ Retirement ÿ Shift/RDO’s

ÿ Prefer not to work at this time ÿ Maternity

ÿ Personal Illness ÿ Family Objection to Prison Environment

ÿ Family Illness ÿ Moving Out of Area

ÿ Return to School ÿ Excessive Traveling Time

ÿ Accepting Another Job ÿ Discontent with Position

ÿ Transfer to Another State Agency ÿ Other: _________________________________________

(Please Specify)________________________

We would like to know how your working conditions were:

ÿ Satisfactory Working Conditions ÿ Unsatisfactory Working Conditions

ÿ Adequate Job Training ÿ Conflict with Supervisor/Co-workers

ÿ Unsuitable Work Hours ÿ Inadequate Job Training

ÿ Conflict of Interest ÿ Lack of Opportunity for Job Advancement

ÿ Potential Risk Involved in Prison Work ÿ Other: ___________________________________

Salary: ÿ Adequate Salary ÿ Inadequate Salary

Are you leaving to accept… ÿ Higher Salary for Similar Position ÿ Higher Salary for Different Position

Please indicate if you are accepting a position in one of the following:

ÿ Federal Government ÿ Self-Employment

ÿ Employment in Private Industry

ÿ Employment for Public Employer (City, County, other, please specify) _______________________

Comments – Please be specific in your comment. Continue on reverse side if necessary:

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