C O M P AN Y N A M E

COMPANY LOGO

Exit Counseling
For your valuable opinion
Name: _________________________________ Supervisor: ______________________________
Department: ________________________

Position: ______________

Emp ID: _______

Date of Joining: ___________________

Date of Confirmation: ___________________

1.

Why you leave?

Personal

Compensation &

Quality of

Work

Reason

Benefits

Supervision

Environment

2.

Rationality of leaving

3.

What circumstances would have prevented your departure?

4.

What did you like most about your job?

5.

What did you like least about your job?

6.

What did you think of your supervisor on the following points:

Criterion

Below
Expectati
on

Meets
Expectatio
ns

Role
Model

Consistently Fair
Provides recognition
Resolve complaints
Sensitive to employee needs
Provides feedback on
performance
Friendly to open
communication
Follows company policies

7.

What Suggestions do you have for our improvements?

8.

If we implemented those suggestions, would you return to work here?

Yes

No

9.

Would you recommend this company to your friends as a good place to work?

Yes

No

In this section, departing employee will

Strongly

Somewhat

Somewhat

Strongly

rate the following statements:

disagree

disagree

agree

agree

10.

Do you believe that you were treated like a

valuable member of the company?

11.

Were your job duties and responsibilities

clearly defined?

12.

Did you receive the proper training required

to perform your job effectively?

1.

Why you leave?

Personal

Compensation &

Quality of

Work

Reason

Benefits

Supervision

Environment

2.

Rationality of leaving

3.

What circumstances would have prevented your departure?

4.

What did you like most about your job?

5.

What did you like least about your job?

6.

What did you think of your supervisor on the following points:

Criterion

Below
Expectati
on

Meets
Expectatio
ns

Role
Model

Consistently Fair
Provides recognition
Resolve complaints
Sensitive to employee needs
Provides feedback on
performance
Friendly to open
communication
Follows company policies

7.

What Suggestions do you have for our improvements?

8.

If we implemented those suggestions, would you return to work here?

Yes

No

9.

Would you recommend this company to your friends as a good place to work?

Yes

No

In this section, departing employee will

Strongly

Somewhat

Somewhat

Strongly

rate the following statements:

disagree

disagree

agree

agree

10.

Do you believe that you were treated like a

valuable member of the company?

11.

Were your job duties and responsibilities

clearly defined?

12.

Did you receive the proper training required

to perform your job effectively?

1.

Why you leave?

Personal

Compensation &

Quality of

Work

Reason

Benefits

Supervision

Environment

2.

Rationality of leaving

3.

What circumstances would have prevented your departure?

4.

What did you like most about your job?

5.

What did you like least about your job?

6.

What did you think of your supervisor on the following points:

Criterion

Below
Expectati
on

Meets
Expectatio
ns

Role
Model

Consistently Fair
Provides recognition
Resolve complaints
Sensitive to employee needs
Provides feedback on
performance
Friendly to open
communication
Follows company policies

7.

What Suggestions do you have for our improvements?

8.

If we implemented those suggestions, would you return to work here?

Yes

No

9.

Would you recommend this company to your friends as a good place to work?

Yes

No

In this section, departing employee will

Strongly

Somewhat

Somewhat

Strongly

rate the following statements:

disagree

disagree

agree

agree

10.

Do you believe that you were treated like a

valuable member of the company?

11.

Were your job duties and responsibilities

clearly defined?

12.

Did you receive the proper training required

to perform your job effectively?

1.

Why you leave?

Personal

Compensation &

Quality of

Work

Reason

Benefits

Supervision

Environment

2.

Rationality of leaving

3.

What circumstances would have prevented your departure?

4.

What did you like most about your job?

5.

What did you like least about your job?

6.

What did you think of your supervisor on the following points:

Criterion

Below
Expectati
on

Meets
Expectatio
ns

Role
Model

Consistently Fair
Provides recognition
Resolve complaints
Sensitive to employee needs
Provides feedback on
performance
Friendly to open
communication
Follows company policies

7.

What Suggestions do you have for our improvements?

8.

If we implemented those suggestions, would you return to work here?

Yes

No

9.

Would you recommend this company to your friends as a good place to work?

Yes

No

In this section, departing employee will

Strongly

Somewhat

Somewhat

Strongly

rate the following statements:

disagree

disagree

agree

agree

10.

Do you believe that you were treated like a

valuable member of the company?

11.

Were your job duties and responsibilities

clearly defined?

12.

Did you receive the proper training required

to perform your job effectively?

1.

Why you leave?

Personal

Compensation &

Quality of

Work

Reason

Benefits

Supervision

Environment

2.

Rationality of leaving

3.

What circumstances would have prevented your departure?

4.

What did you like most about your job?

5.

What did you like least about your job?

6.

What did you think of your supervisor on the following points:

Criterion

Below
Expectati
on

Meets
Expectatio
ns

Role
Model

Consistently Fair
Provides recognition
Resolve complaints
Sensitive to employee needs
Provides feedback on
performance
Friendly to open
communication
Follows company policies

7.

What Suggestions do you have for our improvements?

8.

If we implemented those suggestions, would you return to work here?

Yes

No

9.

Would you recommend this company to your friends as a good place to work?

Yes

No

In this section, departing employee will

Strongly

Somewhat

Somewhat

Strongly

rate the following statements:

disagree

disagree

agree

agree

10.

Do you believe that you were treated like a

valuable member of the company?

11.

Were your job duties and responsibilities

clearly defined?

12.

Did you receive the proper training required

to perform your job effectively?

Additional Comments and Suggestions are encouraged.