Sample: Exit Interview Form

Dear Mr. Ms

On the behalf of the company, we thank you for your services. We appreciate if you take a few minutes to fill out the form.  Your comments are valuable to us.  We remind you that filling out form is voluntary. The information, you will provide us will not be revealed or utilized for any other purpose than internal analysis. The internal analysis will not reveal your identity under any circumstance.

 

Employees Name

 

Date Hired

 

Supervisor’s Name

 

Department

 

Were your job duties and responsibilities what you expected?  --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

What is your frank and hones opinion about your job??  ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

What is your frank and hones opinion about your working conditions?  ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

What is your frank and hones opinion about in-house training programs (if any)?  --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

What is your frank and hones opinion about your pay?  ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

What is your frank and hones opinion about firm’s fringe benefits?  ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

What is your frank and hones opinion about treatment of your manager/supervisor?  -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

What is your major reason for leaving the company?  -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

What could we have done to keep you from leaving?  ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Please feel free to give any other comments ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Signature                                                                                  Dated
  

 

 
   

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