Exit Interview

It is the responsibility of the employee leaving the organization to fill this form and hand it
over to Human Resources to ensure prompt settlement of his/her account:

Personal Information:

Name: ___________________________________________________________

Date of joining: ___________________________________________________________

Employee code: ___________________________________________________________

Position: ___________________________________________________________

Date of Resignation: ___________________________________________________________

Department Details:

Department Name: ___________________________________________________________

Manager Name: ___________________________________________________________

HOD Name: ___________________________________________________________

Last Day Worked: ___________________________________________________________

What are the reason(s) for you to leaving Protinus Infotech Pvt. Ltd.? (Check all that apply)

 Return to Studies  Better Opportunity

 Dissatisfied with Location  Family Reasons
 Dissatisfied with Salary  Illness in Family
 Dissatisfied with Supervisor/Manager  Child Care
 Dissatisfied with Work Load  Marriage
 Dissatisfied with Work Conditions  Relocation
 Health reasons
 Dissatisfied with Promotion Opportunity
 Dissatisfied with Working Hours
 Other - Voluntary ___________________________
(e.g. self-employment, transportation)
What was the single, most compelling factor in your decision?

_____________________________________________________________________________________

_____________________________________________________________________________________

What other factors contributed to your decision?

_____________________________________________________________________________________

_____________________________________________________________________________________

Is, there is anything that Protinus Infotech Pvt. Ltd. could have done differently that would have
changed or delayed your decision?

_____________________________________________________________________________________

_____________________________________________________________________________________

What did you most like about your Job?

_____________________________________________________________________________________

__________________________________________________________________________________

What did you like least about your job?

_____________________________________________________________________________________

_____________________________________________________________________________________

If leaving for better opportunity:

With whom: __________________________________________________________________________

What Designation: _____________________________________________________________________

Would you recommend Protinus Infotech Pvt. Ltd. to a friend as a place to work?

Yes: ______________ No: _______________

Why: ________________________________________________________________________________

Is there any particular point you would like to record (in strictest confidential between you and
management) which may help management be aware of certain factors of which they might be
unaware?

_____________________________________________________________________________________

_____________________________________________________________________________________

____________________________________________________________________________________

(SIGNATURE OF THE EMPLOYEE)

Summary (to be completed by HR Manager):

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

(SIGNATURE OF HR MANAGER)