Exit Interview 

Form
Name: Enterprise ID: Work Order ID :
Date of Joining: Date of Exit:
Personal Mail ID: Mobile number:

The objective of this questionnaire is to elicit your honest feedback using which the organization can
learn from its shortcomings. All information provided by you will be kept confidential and used only
for organizational improvement. Consider this feedback as a parting gift to us.

Assets / Items for Return

Y☐ / N☐ /
Keys (office/desk/cupboard) ID card Y☐ / N☐ / NA☐
NA☐
Y☐ / N☐ /
Laptop/IT equipment
NA☐ Other Items (give details):

Choose the Reason for leaving:

Yes No
Conversion  ☐  ☐
Project Roll off  ☐  ☐
Termination  ☐  ☐
Resignation (If Resignation, please tick the correct reason
below)  ☐  ☐

☐Took another position ☐Dissatisfaction with salary

☐Poor health/physical disability ☐Dissatisfaction with type of work
☐Pregnancy/home/family needs ☐Dissatisfaction with supervisor
☐Relocation to another city ☐Dissatisfaction with co workers
☐Travel difficulties ☐Dissatisfaction with working conditions
Dissatisfaction with Shift timings Yes ☐ No ☐ Interested for Night shift Yes ☐ No ☐
Other (specify) ________________________________________

1 What are the two most crucial reasons for leaving the organization?  
2 Would you like to rejoin the organization in the future? (Yes / NO )  

Excellen Fai
Good Poor
Experience with Supplier: t r
Payment processing
 ☐  ☐  ☐  ☐
Vendor Response on your
queries  ☐  ☐  ☐  ☐
Experience with employer  ☐  ☐  ☐  ☐

Additional Comments: _______________________________________________________

 Exit Interview Form

Date : Employee Signature :