EXIT INTERVIEW FORM

NAME :……………………………………………………………………………………………………………………………………….

ADDRESS:…………………………………………………………………………………………………………………………………….

DESIGNATION : ………………………………………..DEPT. :………………………………………………………………………….

DATE OF RESIGNATION :………………………………………………………………………………………………………………

DATE OF JOINING :…………………………. DATE OF SEPRATION :………………………………………………………..

 Are you leaving the job because of :

One reason Multiple reason

 What are the reasons of your leaving the job please tick and mark most adverse effect as 1,then
2,then 3,….(in case of multiple reasons) and also put a remark in the list below :

Relationship with immediate superior

Relationship with superior’s superior
Relationship with HOD
Better prospect
Hierarchy
Personal reason
Staying problem
Children education
Utilisation of potential
Lack of clarity of job
Proximity to move/family
Others

 Did you receive respect from your superior ? To what extent ?

Please circle one : (not at all) 1 2 3 4 5 (best)

1 2 3 4 5

 Did you receive respect from your superior’s superior ? To what extent ?
Please circle one : (not at all) 1 2 3 4 5 (best)

1 2 3 4 5

 Did you receive respect from your HOD/unit head ? To what extent ?
Please circle one : (not at all) 1 2 3 4 5 (best)

1 2 3 4 5

 How do you find the present emoluments in comparison to next employment ?

LOW VERY LOW COMPARABLE HIGH

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 ALUDECOR LAMINATION PVT. LTD.
EXIT INTERVIEW FORM

 Are you clear on what you needed to do (i.e. your job) here ? To what extent ?
Please circle one : (not at all) 1 2 3 4 5 (best)

1 2 3 4 5

 Did you receive freedom to work and make decision ? To what extent ?
Please circle one : (not at all) 1 2 3 4 5 (fully)

1 2 3 4 5

 Did you receive appreciation for job well done ? To what extent ?
Please circle one : (never) 1 2 3 4 5 (always)

1 2 3 4 5

 Did you think/feel your work was important ? To what extent ?

Please circle one : (never) 1 2 3 4 5 (always)

1 2 3 4 5

 Did you receive guidance from your superior ? To what extent ?

Please circle one : (never) 1 2 3 4 5 (always)

1 2 3 4 5

 Did your superior criticise you in front of others ? To what extent ?

Please circle one : (never) 1 2 3 4 5 (always)

1 2 3 4 5

 How was the relationship with your teammates ?

Please circle one : (poor) 1 2 3 4 5 (very good)

1 2 3 4 5

 How was the work environment ?

Please circle one : (poor) 1 2 3 4 5 (very good)

1 2 3 4 5

 How was the salary structure of the Company ?

Please circle one : (poor) 1 2 3 4 5 (very good)

1 2 3 4 5

 How are the rules and regulations of the Company ?

Please circle one : (poor) 1 2 3 4 5 (very good)

1 2 3 4 5

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 ALUDECOR LAMINATION PVT. LTD.
EXIT INTERVIEW FORM

 Give three no. of strengths and weaknesses of the Company ?

Strength i)
ii)
iii)
Weakness i)
ii)
iii)

 Your specific suggestions for improvement :

For your own department

For other departments

For Company as a whole

What specific action if taken would have enabled you to continue in this Company ?

…………………………………………………………………………………………...…………………………………………………
……………………………………….…………………………………………………………………………………………
Were there any company policies or procedures that made your work more difficult?
……………………………………………………………………………………………………………………………………………………………………
…………………………Would you consider returning to this company in future?
……………………………………………………………………………………………………………………………………………………………………
…………………………
Would you recommend this company to a friend as a good place to work?
……………………………………………………………………………………………………………………………………………………………………
…………………………

 Any other comments (if any) :

 Comments by the ZH :

 Assessment of this separation :BY HR

Thank you for your feedback and it would be kept confidential and your suggestion views may be used in improvisation in
policy/practices and environment.

Date :……………………
Place :………………….. Interviewed by : ………………………………………

 The form must be filled in after the Interview is completed

 Please inform the interviewee that main purpose of the Interview is to consolidate on the
strengths and overcome the weaknesses of the Company