EXIT INTERVIEW QUESTIONNAIRE

EXIT INTERVIEW QUESTIONNAIRE

Employee Name: ____________________    Current position: __________________

Initial employment date: ______________    Date of Resign: ___________________

Last date of employment: ____________

1.      At approximately what point in time did you begin making your decision to resign?

 6-9 months ago                                              3-5 months ago

 1-2 months ago                                              other ________________

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2.      Please indicate reason(s) below, which contributed to your decision to resign your current position?

 Salary                                                Family Responsibilities

 Job Advancement                             Dissatisfied/Management

 Personal                                             Benefits

 Job Eliminated                                  Relocation                                    

 Health Retirement                             Other – (please explain) ________________

3.      Was there a specific event of issue that prompted your resignation?

Yes    No 

         If yes, please briefly explain: 

__________________________________________________________________________________________________________________________________________________

           

        If yes, did you discuss this matter with your manager/ director?

         Yes    No

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

On a scale of 1 to 5, with “1” being poor and “5” being outstanding, please rate the   following:

4. Quantity and quality of training received for your position(s) here at _________.

1     2     3     4     5

__________________________________________________________________________________________________________________________________________________

5. Working relationship with your departmental in-charge.

1     2     3     4     5

__________________________________________________________________________________________________________________________________________________

6. Working relationship with fellow employees.

1     2     3     4     5

__________________________________________________________________________________________________________________________________________________

7. Behavior of Top Management.

1     2     3     4     5

_________________________________________________________________________________________________________________________________________________

8. Salary for your position.

1     2     3     4     5

__________________________________________________________________________________________________________________________________________________

9. Employee Benefits package.

1     2     3     4     5

Please offer any comments or suggestions for improvement related to the Benefits package. __________________________________________________________________________________________________________________________________________________

10. Overall workload for your position.

1     2     3     4     5

11. Overall satisfaction and enjoyment in your current position.

1     2     3     4     5

__________________________________________________________________________________________________________________________________________________

12. Did you encounter any problems in your current position? Yes    No

If yes, please briefly comment:

__________________________________________________________________________________________________________________________________________________

13.  What did you enjoy most about your employment with ________?

__________________________________________________________________________________________________________________________________________________

14.  What did you enjoy least about your employment with _______________?

__________________________________________________________________________________________________________________________________________________

15. Based upon your experiences here, would you recommend _____________ as a potential employer for your friends, relatives, etc.?            Yes    No

If no, please briefly explain:

__________________________________________________________________________________________________________________________________________________

15. Would you reapply to ______ if a future opportunity arose?            Yes    No

 If no, please briefly explain:

__________________________________________________________________________________________________________________________________________________

Please add any additional comments:

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Employee Sign: ______________

Exit interview conducted by: __________________ Date/Time: _________________