Exit Interview Form

Employee Name Employee code

Division Designation
Date of Joining Date of leaving

1. Reasons for leaving (Please specify reasons in the space below the applicable factors)
a) Work-related
i. Work Environment: Excellent / Very Good / Good / Satisfactory / Poor

ii. Job Satisfaction: Excellent / Very Good / Good / Satisfactory / Poor

iii. Support from your Immediate Manager: Excellent / Very Good / Good / Satisfactory / Poor

iv. Rapport with your colleagues: Excellent / Very Good / Good / Satisfactory / Poor

v. Management Style: Courteous / Helpful / Problem Solving

vi. Training Provided: Excellent / Very Good / Good / Satisfactory / Poor

vii. Infrastructure Provided: Excellent / Very Good / Good / Satisfactory / Poor

b) Better Prospects
i. What will be your new designation and role?

ii. Are you taking up additional responsibilities?

iii. Have you got a better compensation, if so how much?

iv. Which platform are you going to work on?

v. Have you received any overseas work opportunities? If so, which is the place of work?

vi. Which is your field of interest? Are you planning for further studies, if so, in which field?

vii. Are you planning to relocate, if so to which place?

c) Personal Reasons
i. Financial Constraint

ii. Relocation to Hometown

iii. Further Studies

iv. Better Work Atmosphere

v. Marriage

vi. Family Problem

2. What circumstances would have prevented your departure? (Please specify reasons in
the space below the applicable factors)
i. Better Work Atmosphere

ii. Better Guidance and Support from your Supervisor

iii. Better Employee Interaction

iv. Additional Support from the Management

v. Better Compensation and Benefit

vi. Additional Roles and Responsibilities

vii. Additional Employee Benefits

viii. Advanced Training in your Field

3. What did you like most about your job?

4. What did you like least about your job?

5. What did you think of your supervisor on the following points?

Almost
Usually Sometimes Never
Always
Was consistently fair [] [] [] []
Provided recognition [] [] [] []
Resolved complaints [] [] [] []
Was sensitive to employee
[] [] [] []
needs
Provided feedback on
[] [] [] []
performance
Was receptive to open
[] [] [] []
communications

6. How would you rate the following?

Excellent Good Fair Poor

Cooperation within your
[] [] [] []
division/program
Cooperation with other
[] [] [] []
divisions
Personal job training [] [] [] []
Equipment provided
(materials, resources, [] [] [] []
facilities)
Company’s performance
[] [] [] []
review system
Company’s employee
[] [] [] []
orientation program
Rate of Pay for your Job [] [] [] []
Career
Development/Advancement [] [] [] []
Opportunities
Physical Working Conditions [] [] [] []

7. Was the work you were doing what you expected it to be?
[ ] Yes [ ] No
Comments:

8. Was your workload usually:

[ ] Too heavy [ ] About right [ ] Too light
Comments:

9. How did you feel about the employee benefits provided by the company?
[ ] Excellent [ ] Good [ ] Fair [ ] Poor [ ] No Opinion
Comments:

10. Would you recommend the company to a friend?

[ ] Most definitely [ ] With Reservations [ ] No
Comments:
11. What suggestions do you have to make this a better a place to work?

12. Are you open to the idea of re-joining the organization at a future date?

Summary of Interview: