CONFIDENTIAL

EMPLOYEE EXIT INTERVIEW FORM

DATE:

NAME OF EMPLOYEE: _______________________________________________

POSITION & LEVEL:
DATE HIRED:
DIVISION/DEPARTMENT:
IMMEDIATE SUPERVISOR:
EFFECTIVE RESIGNATION DATE:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

Part I. REASON/S FOR LEAVING

1. What is/are your reason/s for leaving?

2. What are your plans after you leave FPG Insurance?

a. If you are taking another job, what kind of work will you be doing and where?

b. What has your new place of employment offered you that attracted you the most (salary,
benefits?

3. Could the company have made any improvements that might have led you stay on the job?

Part II. COMMENTS/SUGGESTIONS FOR IMPROVEMENT

1. What did you like most about your stay with FPG Insurance?

2. What did you like least about your stay with FPG Insurance?

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EMPLOYEE EXIT INTERVIEW FORM
3. How did you feel about the pay and benefits?

Excellent Good Fair Poor

a. Rate of pay for your job
b. Guaranteed bonuses
c. Number of paid leaves (SL, VL, EL,
etc.)
d. Medical coverage for self
e. Medical coverage for dependents
f. Medicine reimbursement for self
g. Medicine reimbursement for
dependents
h. Life & Accident Insurance
i. Company loans

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

4. How did you feel about the following:

Very Slightly Neutral Slightly Very
Satisfied Satisfied Dissatisfie Dissatisfied
d
 Opportunity to use your abilities
 Recognition for the work you did
 Training/s you’ve received
 Your supervisor’s leadership skills
 Your opportunity to talk and discuss with
your supervisor
 The information you received on policies,
programs, projects, and problems
 The information you receive on
departmental structure
 Promotion policies & practices
 Discipline policies & practices
 Job transfer policies & practices
 Overtime policies & practices
 Performance review policies & practices
 Physical working conditions
 Company events & activities for employees

REMARKS:

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EMPLOYEE EXIT INTERVIEW FORM
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

5. Would you recommend to your friends and colleagues to apply for FPG Insurance?

6. If given a chance, would you consider reapplying to FPG Insurance?

By signing below, I hereby certify that all information written on this form is true and accurate to the best of my
knowledge and I allow the human resources department and the management to use these information for
further study for the future improvements of the company.

___________________________
Employee’s Name & Signature

Interviewed by: _____________________________

HR

Noted by: _____________________________

Daisy Anne T. Agpoon
Human Resource Manager

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