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Exit Questionnaire

Staff Information
Name : _________________________ Staff No. : _____________________

Div / Dept : _________________________ Last Position : _____________________

Date of Join : _________________________ Last Working Date : _____________________

Reason for Leaving (Please tick ONE only)

 Reasons Please Specify


A. Dissatisfied with Remuneration  Expected pay rate: $__________ i.e._______% increment
Package  no. of Leave day (Annual Leave, Day-off, etc.)
 Medical benefit  Others: ___________________________
B. Dissatisfied with Present Job Nature Do you have new job offer? (If yes, please state) Yes No.

or Change in Career Interest  Company name / Nature: ______________________________

(e.g. Customer Service, Marketing...etc.)  Job Nature / Position: _________________________________

 New Salary: $________________ i.e._______% increment


C. Dissatisfied with Career Prospect
D. Heavy Workload / Long Working

Hours
E. Dissatisfied with Working Condition  Shift Duty  Frequent Travel  Others: ______________
F. Conflict with Supervisors or Peers
G. Low Job Satisfaction or Morale
H. Dissatisfied with Company Policy
I. Dissatisfied with Work Location
J. Further Education

K. Family Issue  Affairs  Take care of family members


L. Personal Reason  Health  Emigration  Others: _______________________
M. Others, please specify:

Are you interested in rejoining our company in the future? (Please tick where appropriate)

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Updated July 2020
Form No: HRD004F
Yes. ( Please specify the job nature: __________________________________________ )
No. ( Please specify the reason: ____________________________________________ )

Other Comments:

Signed by the leaver: ______________________


Date: ______________________

To be completed by the Human Resources Department

Conducted / Received By: ____________________


Date: ____________________

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Updated July 2020
Form No: HRD004F

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