EXIT INTERVIEW FORM
EMPLOYEE PARTICULARS
Employee Name: Date of Joining:
Employee Code: Date of Confirmation:
Designation: Date of Resignation:
Department: Reporting Manager:
Today’s Date: Last Working Day:
1. Separation Type:
Resignation with Notice Termination
Resignation without Notice Other
2. Please specify the reasons for leaving.
Higher salary Non-competitive benefits
Career advancement/change Transportation problems
Personal Reason Dissatisfaction with supervision
Received an employment offer
Lack of job security
without actively seeking another job
Dissatisfied with organizational Dissatisfied with hours and working
culture conditions
Dissatisfied with job Unresolved complaint/Unfair
treatment
Retirement Transportation issue
Other:
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April 2013
3. Is there anything that we could have done differently that would have influenced you
to stay longer with the Company?
4. Do you believe you received adequate support from management? Explain.
5. How do you compare the current job and its benefits with your new job?
6. Did you find your job or your work challenging and rewarding? Why?
7. Did your job turn into what was described to you during the job interview process?
8. Please give suggestions which will make this a better place to work.
9. Would you consider returning to our organization in the future?
10. Variables Excellent Good Fair Poor
Job Duties/Workload
Salary
Benefits
Working Conditions
Work Environment & Working Hours
Degree of Supervision
Relationship with Supervisor
Training and Development
Policies and Procedures
Advancement Opportunities
Recognition/Satisfaction
Performance Appraisals
Morale
Employee Signature: Human Resources:
HRF-004 Page 2 of 2
April 2013