Exit Interview / Survey

• Employee Name (Last, First, Middle)

• Position

• Conducted on

  Date

• Exit Interview Conducted By:

• Location
  Address

Exit Interview / Survey

• Why are you leaving?

  Select Salary Job Advancement Personal Return to School Relocation Health Retirement Family Responsibilities Dissatisfied / Management Benefits Job Eliminated Other

  • Salary
  • Job Advancement
  • Personal
  • Return to School
  • Relocation
  • Health Retirement
  • Family Responsibilities
  • Dissatisfied / Management
  • Benefits
  • Job Eliminated
  • Other

• Please specify

• Was there a specific event of an issue that prompted your resignation?

  Yes

  No

• Please briefly explain

• Did you discuss this matter with your supervisor / manager?

  Yes

  No

• Were you comfortable talking to your manager about work problems?

  Yes

  No

• Did you feel you were kept up to date on new developments and company policies?

  Yes

  No

• Were you given the tools to succeed at your job?

  Yes

  No

• What was your best or worst day on the job?

• What did you like most about your job? And what would you change about it?

• How likely are you to recommend working with our organization to your friends or family members?

• Why or why not?

• Are there any other unresolved issues or additional comments?

• What could we have done better?

COMPLETION

• Name & Signature of Employee

  Sign