Title Page
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Employee Name (Last, First, Middle)
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Position
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Conducted on
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Exit Interview Conducted By:
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Location
Exit Interview / Survey
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Why are you leaving?
- Salary
- Job Advancement
- Personal
- Return to School
- Relocation
- Health Retirement
- Family Responsibilities
- Dissatisfied / Management
- Benefits
- Job Eliminated
- Other
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Please specify
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Was there a specific event of an issue that prompted your resignation?
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Please briefly explain
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Did you discuss this matter with your supervisor / manager?
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Were you comfortable talking to your manager about work problems?
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Did you feel you were kept up to date on new developments and company policies?
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Were you given the tools to succeed at your job?
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What was your best or worst day on the job?
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What did you like most about your job? And what would you change about it?
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Why or why not?
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Are there any other unresolved issues or additional comments?
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What could we have done better?
COMPLETION
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Name & Signature of Employee