EXIT INTERVIEW FORM

EMPLOYEE PROFILE

Name : __________________________________

Unit : __________________________________

Last Position Held : __________________________________

Last Supervisor : __________________________________

Date Hired : __________________________________

Effectivity of Resignation : ________________________________________

Date of Exit Interview : __________________________________

Signature of Resigning
Employee : ________________________________________

HR Interviewer’s Signature : __________________________________

Note: Please submit this Exit Interview Form and Questionnaires immediately to HR and inquire of your
schedule for the exit interview.
 EXIT INTERVIEW QUESTIONNAIRE

A. On a scale of 1 – 5, indicate how each factor contributed to your decision to resign.

5 4 3 2 1
FACTORS Very Strongly Had Some Had Little Had No
Strongly Contributed Bearing on Influence on Influence
Contributed Decision Decision on Decision
Nature of the Job
Salary
Company Benefits
Opportunities for Advancement
Relationship with Peers
Relationship with Supervisors
Company Systems, Policies
and Practices
Work Environment / Climate
Company Goals, Vision and
Mission
Other Factors (please specify)

B. Please check the box which corresponds to your opinion concerning each of the following statements.

Strongly Strongly
STATEMENTS Agree Neutral Disagree
Agree Disagree
I like my job.
I felt a sense of fulfillment with the job
that I did
I was given adequate and relevant
training to be effective in my job
The amount of work I was given was just
Enough
My job offered a lot of opportunities for
growth and career development
I was given due reward / recognition for
my achievements / contributions to the
team and the company as a whole
My supervisor was technically competent
 Strongly Strongly
STATEMENTS Agree Neutral Disagree
Agree Disagree
I find my supervisor’s management style
Effective.
My supervisor was interested in my
growth and career development
My supervisor (as a leader) earned my
Respect
There was good rapport between my
supervisor and me
Company policies and procedures are
clearly communicated to us
Company policies and procedures
promote organizational effectiveness
and productivity

STATEMENTS Strongly Agree Neutral Disagree Strongly

Agree Disagree
Company benefits are adequate and
Competitive
Our performance appraisal system is fair
The environment in our office is
conducive for working
There was cooperation and teamwork in
our unit
My relationship with unit mates was
friendly as well as professional
I am proud to be associated with this
Company.
I would recommend this company to a
friend
I believe that this company exists to
render quality service to the public

Chances for career advancement is

offered by the Company to deserving
employees
Top Management practices were fair

Our salary increases were fair and

Adequate.
 EXIT INTERVIEW QUESTIONAIRE

C. We will appreciate your honesty in answering the following questions:

Papahalagahan namin ang iyong katapatan sa pagsagot sa mga sumusunod na katanungan:

1. What are some factors that made your employment here enjoyable?
Ano ang ilang mga kadahilanan na nagpasaya sa iyong trabaho dito?

2. Try to recall your happiest experience/memory in the company. What caused you to experience so much joy or
feel very proud of working for the company then?
Subukang alalahanin ang iyong pinakamasayang karanasan sa kumpanya. Ano ang nagdulot sa iyo ng
karanasan na labis mong ikinasaya o pakiramdam mong maipagmamalaki mo para sa kumpanya?

3. What can make this company a better place to work for?

Ano sa palagay mo ang mahusay na pamamaraan ng kumpanyang ito upang maging kanais nais na
paglingkuran?

4. If you are moving to another job, what does that new job offer that your job in this company did not?
Kung lilipat ka sa ibang kompanya, ano ang inalok ng bagong kompanya na iyon na wala sa kumpanyang ito?

5. Do you wish to point out a wrong committed to you in the past by management, your supervisor, or your peers
so that it will not be repeated in the future?
Meron ka bang nais na ihayag tungkol sa mga maling nagawa sa iyo sa nakaraang pamamahala o iyong
supervisor o ng iyong mga kapantay upang hindi na ito maulit sa hinaharap?