Exit Interview Questionnaire

Thank you for your service to the Company. Since you are ending your employment here, I wish to conduct an exit interview with you. I’d like to gain insight into your experiences, both good and bad, to help improve the working conditions of current and future employees.

Please accomplish this questionnaire. I would appreciate your honest feedback. Rest assured your responses will remain CONFIDENTIAL.

* Name

* Position

* Dept/Branch/Company

* Immediate Head

* Date Hired

* Date of Resignation

* 1. The reason(s) that you are leaving the Company is/are: (check appropriate box/es)

A job offer you can't refuse	Inadequate pay and benefits
Limited career advancement opportunities	Difficulty with working condition -ex. schedule, location, etc.
Unhappy with job duties	Unhappy with supervision
Relocation; moving out of the area	Others

1. a. If one of your reasons is difficulty with working condition, please specify if

schedule	location
customers	Others

* 2. What triggered your decision to leave the Company?