EXIT INTERVIEW

Name of
employee& Emp : Name of Supervisor :
number

Designation : Department :

Date Joined : Last day of service :

This form is to be treated and kept CONFIDENTIAL

1) Please explain your reason(s) for leaving the company (Personal, C&B, Management, Work environment)

2) What suggestions for improvement do you have for us?

3) If we implemented those suggestions, would you return to work here? Yes No

4) Would you recommend this company to your friends as a good place to work? Yes No

In this section, please rate the following statements:

Strongly Somewhat Somewhat Strongly

agree agree disagree disagree

1. I believe that I was treated like a valuable member

of the company

2. My immediate supervisor let me know when I was

doing a good job

3. I felt free to suggest to my supervisor changes that

would improve my department

4. My job duties and responsibilities were clearly

defined

5. I received the proper training in order to perform my

job effectively

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 Strongly Somewhat Somewhat Strongly
agree agree disagree disagree

6. Employee problems and complaints were resolved

fairly and promptly in my department

7. If I had questions or concerns, I felt comfortable

speaking with:

8. My immediate supervisor

9. Upper management

10.HR

11. I was kept well informed about the company, its

policies and procedures and other important information

12.I felt that the company provided me with job security

5) Additional comments and suggestion are encouraged

Signature of Employee Date

Name & Signature of Reviewer/ Interviewer Date

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