Fill and Sign the Exit Interview Questionnaire Form

Exit Interview Questionnaire Employee _______________________________ Supervisor _______________________________ Department _______________________________ Job Title _______________________________ Hire Date _______________________________ Termination Date _______________________________ 1. Reason for leaving company (check all that apply): Better job opportunity Return to school Commuting distance Switching careers Self-employment Moving out of area Increase in pay Conflict with management Other ___________ Conflict with other employees Illness or physical condition ________________ No room for advancement Family circumstances ________________ 2. Please rate the following: Low High Policies and procedures practiced? 1 2 3 4 5 6 7 Employee treatment? 1 2 3 4 5 6 7 Job recognition? 1 2 3 4 5 6 7 Job satisfaction? 1 2 3 4 5 6 7 Department cooperation? 1 2 3 4 5 6 7 Communication between departments? 1 2 3 4 5 6 7 Communication throughout company? 1 2 3 4 5 6 7 Employee complaints procedure? 1 2 3 4 5 6 7 On the job training? 1 2 3 4 5 6 7 Necessary resources for job? 1 2 3 4 5 6 7 Ability to voice ideas/suggestions? 1 2 3 4 5 6 7 Employee morale? 1 2 3 4 5 6 7 Advancement opportunities? 1 2 3 4 5 6 7 Comments: _________________________________________________________ 3. Please rate the following: Excellent Good Fair Poor Not Applicable Salary [ ] [ ] [ ] [ ] [ ] Medical Benefits [ ] [ ] [ ] [ ] [ ] Dental Benefits [ ] [ ] [ ] [ ] [ ] Vision Benefits [ ] [ ] [ ] [ ] [ ] Retirement Plan [ ] [ ] [ ] [ ] [ ] Life Insurance [ ] [ ] [ ] [ ] [ ] Paid-time-off [ ] [ ] [ ] [ ] [ ] STD/LTD Plan [ ] [ ] [ ] [ ] [ ] Other _________________ [ ] [ ] [ ] [ ] [ ] Comments: ___________________________________________________________ 4. How often did you receive feedback on your performance? _______________________ ________________________________________________________________ 5. What are your thoughts on the performance review process? _____________________ _____________________________________________________ 6. What did you like most about your job and this company? ________________________ _________________________________________________________ 7. What did you like least about your job and this company? ________________________ ___________________________________________________________________ 8. Do you have any suggestions for improvement? _________ _______________________ _________________________________________________________________ __________________________ __________________________ Company Representative Employee Date:____________________ Date:____________________