Exit Interview

Please take a moment and complete the following questionnaire. We regret losing an employee and hope that through this questionnaire we can identify problem areas and rectify undesirable situations. This form will not become a part of your personnel file, and will not affect your rehire status. Your cooperation is appreciated.

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1. Reason for leaving? *
2. Opportunity for Advancement
10. Working Conditions
11. Benefits and Pay
2. If you are leaving for a new position what makes it more attractive than the one you are leaving? *
1. Wage and Benefits
2. Opportunities/Advancement
3. Working Conditions
5. Location
3. How would you rate the following?
Performance Reviews
B. Good
Comments
Opportunity for Advancement
B. Good
Comments
Training Received
B. Good
Comments
Company Policies and Practices
B. Good
Comments
Responsibilities
B. Good
Comments
Hours
B. Good
Comments
Support by Management
B. Good
Comments
Work Load
B. Good
Comments
Salary
C. Fair
Comments
Benefits
C. Fair
Comments
Are there any additional benefits you would like to receive?
4. Did your Supervisor:
Demonstrate fair and equal treatment?
A. Yes
Comments
Provide recognition on the job?
A. Yes
Comments
Keep employees well informed?
A. Yes
Comments
Make themselves available for discussion of any problems or potential problems?
B. No
Comments
Encourage feedback?
A. Yes
Comments
Explain the position and responsibilities of the job you held?
B. No
Comments
5. What is your opinion of the job you had with us?
N/A
6. What were some of the frustrations you experienced in the performance and execution of job responsibilities?
N/A
7. Would you be willing to stay with our Company under a more satisfactory arrangement?
B. No
What changes would be required?
Overall Comments
Form Status: Approve

Draw Signature

Date 2023-09-26
Deny Re-take Approve

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