Exit Interview

A : No.
211 Tran Nao Street, Binh An Ward, District 2, Ho Chi Minh City, Vietnam 
Phone: +84 28 6271 1128
E-mail: info@vinestate.com – Web: www.vinestate.com
EXIT INTERVIEW QUESTIONNAIRE
Employee Name: ____________________ Supervisor Name: __________________
Initial employment date: ______________ Last date of employment: ____________
Current position: ____________________________________
1. At approximately what point in time did you begin making your decision to resign?
6-9 months ago 3-5 months ago

1-2 months ago other ________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
2. Please indicate reason(s) below, which contributed to your decision to resign your current
position?
Salary Family Responsibilities

Job Advancement Dissatisfied/Management
Personal Benefits
Return to School Job Eliminated
Relocation Other – (please explain) ________________
Health Retirement Military
3. Was there a specific event of issue that prompted your resignation?
Yes No
If yes, please briefly explain:

_________________________________________________________________________
_________________________________________________________________________
If yes, did you discuss this matter with your supervisor/manager?
Yes No
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Page 1 of 4
A : No. 211 Tran Nao Street, Binh An Ward, District 2, Ho Chi Minh City, Vietnam 
Phone: +84 28 6271 1128
Exit Interview Questionnaire

Page two (2)
On a scale of 1 to 5, with “1” being poor and “5” being outstanding, please rate the
following:
4. Quantity and quality of training received for your position(s) here at VINestate.
1 2 3 4 5
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
5. Working relationship with your current supervisor.
1 2 3 4 5
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
6. Working relationship with fellow employees.
1 2 3 4 5
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
7. Salary for your position.
1 2 3 4 5
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Page 2 of 4
Phone: +84 28 6271 1128

Page three (3)
8. Employee Benefits package.
1 2 3 4 5
Please offer any comments or suggestions for improvement related to the Benefits package.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
9. Overall workload for your position.
1 2 3 4 5
10. Overall satisfaction and enjoyment in your current position.
1 2 3 4 5
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
11. Did you encounter any problems in your current position? Yes No
If yes, please briefly comment:

_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
12. What did you enjoy most about your employment with VINestate?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Page 3 of 4
Phone: +84 28 6271 1128
Page four (4)
13. What did you enjoy least about your employment with VINestate?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
14. Based upon your experiences here, would you recommend VINestate as a potential
employer for your friends, relatives, etc.? Yes No
If no, please briefly explain:

_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
15. Would you reapply to VINestate if a future opportunity arose? Yes No
If no, please briefly explain:

_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Please add any additional comments:

_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Exit interview conducted by: ____________________
Date/Time: _________________
Exit Questionnaire 7/18/01
Page 4 of 4

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A : No.

EXIT INTERVIEW QUESTIONNAIRE

Employee Name: ____________________ Supervisor Name: __________________

Initial employment date: ______________ Last date of employment: ____________

Current position: ____________________________________

6-9 months ago 3-5 months ago

Salary Family Responsibilities

3. Was there a specific event of issue that prompted your resignation?

If yes, please briefly explain:

If yes, did you discuss this matter with your supervisor/manager?

Exit Interview Questionnaire

5. Working relationship with your current supervisor.

6. Working relationship with fellow employees.

7. Salary for your position.

Exit Interview Questionnaire

8. Employee Benefits package.

9. Overall workload for your position.

10. Overall satisfaction and enjoyment in your current position.

If yes, please briefly comment:

If no, please briefly explain:

15. Would you reapply to VINestate if a future opportunity arose? Yes No

If no, please briefly explain:

Please add any additional comments:

Exit interview conducted by: ____________________

Exit Questionnaire 7/18/01

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