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Exit Interview Form

The employee was asked to complete an exit interview form to provide feedback on their experience working at the company. They were assured that individual responses would remain confidential to HR and not be held against them. The form asked the employee to rate and comment on their direct supervisor, benefits, job duties, compensation, opportunities, and company communication. It also asked if they would return or refer others to the company in the future, as well as the reasons for leaving and any suggestions. The employee was thanked for their time.

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Kat Aragoza
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508 views4 pages

Exit Interview Form

The employee was asked to complete an exit interview form to provide feedback on their experience working at the company. They were assured that individual responses would remain confidential to HR and not be held against them. The form asked the employee to rate and comment on their direct supervisor, benefits, job duties, compensation, opportunities, and company communication. It also asked if they would return or refer others to the company in the future, as well as the reasons for leaving and any suggestions. The employee was thanked for their time.

Uploaded by

Kat Aragoza
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 4

Exit interview form

We appreciate you taking a few minutes to answer the following questions.


Please be as honest as possible. While we may share some of this information
with management, individual responses will remain confidential to the Human
Resources department, and will not be held against you.

/ /

Employee name Date

/ / / /

Date of hire Last date of employment

Job title Department

01 Please rate your direct supervisor on the following

Excellent Good Fair Poor

Clearly communicated expectations

Held weekly or biweekly 1:1 meetings to discuss my projects and work

Provided consistent and regular feedback about my work

Provided leadership, guidance and motivation to the entire team

For any items not marked “Excellent,” please explain why:

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02 Please rate the company’s benefits, perks and workplace experience

Excellent Good Fair Poor

Healthcare, dental and vision insurance coverage

Life insurance

401(k) plan

Flexibility and work-life balance

PTO policy (including vacation, sick days and paid holidays)

Workspace and equipment

Company-sponsored events

For any items not marked “Excellent,” please explain why:

03 Please rate the company’s benefits, perks and workplace experience


Agree
Agree Somewhat Disagree

The job description provided an accurate representation of the duties your


role entailed

I feel I was well-trained and set up for success

I feel my compensation was fair for my role and responsibilities

I was provided opportunities for advancement throughout my employment

My role and responsibilities changed dramatically throughout my employment

My role allowed me to apply my best skills and use of my greatest strengths

For any items not marked “Agree,” please explain why:

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04 Please rate the company on the following

Excellent Good Fair Poor

Communication with employees regarding updates and changes

Communication with employees regarding internal opportunities

Communication of company mission, vision and objectives

Cross-department communication, collaboration and cooperation

PTO policy (including vacation, sick days and paid holidays)

Communicating and upholding company culture

For any items not marked “Excellent,” please explain why:

05 Please rate the following statements as true or false

True False

I would consider returning to the organization in the future

I would feel comfortable referring someone else to work here

06 Why are you choosing to leave the company?

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07 Is there anything we could have done that would have changed your decision to leave?

08 Other feedback (optional)

Thank you for your time!


We wish you the best of luck in your future endeavors.

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