Exit Interview Questionnaire

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EXIT INTERVIEW

Employee: ________________________________ Hire Date: ____________________

Job Title: _________________________________ Department: __________________

Supervisor: _______________________________ Termination Date: _____________

1. Was your decision to leave influenced by any of the following?


Please check all those applicable.

Reason for Leaving the Organization

Leaving the area Health reasons


Returning to lndia Family circumstances
Dissatisfied: Retirement
Type of work Career opportunity
Working conditions
Salary
Supervision

Other

2. Is there anything that could have been done to prevent you from leaving?

3. What responsibilities and duties do you have at your new job?

4. What does your new job offer that your job at Adaequare does not?

5. What was the most satisfying aspect of your job? What was least satisfying?

6. Was your salary satisfactory to the job you were performing?


7. Did any organization policies or procedures (or any other obstacles) make your job more
difficult?

8. Are there any particular practices or working conditions or policies that you feel are
particularly beneficial to an effective working relationship and that should be maintained?

9. Would you ever be interested in coming back to work for us

10. Would you recommend this organization to others as a place to work? Why or why not

11. As a learning organization, we very much appreciate you highlighting your concerns in such
an open manner so that we can explore avenues for improvement. Having been with the
organization for this period, are there areas that you think we have learned as a result and
made efforts to improve?

Interview Conducted By: ____________________________ Date: ______


********** To be completed by Human Resources Department ***********

Type of Termination:

[ ] Resignation with notice [ ] Resignation with no notice

[ ] Early Retirement [ ] Retirement

[ ] Layoff [ ] Termination

Other: __________________________________________________________________

Employee’s File

Performance Evaluations

HR Observations

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