Employee Exit Interview - Download Now DOC by docsourcenow


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                                                                                         Company Name Here

                                                                  Exit Interview
About You
Providing us with some general information about you is helpful. The information we’d like to have the most is notated with an (*).
Name: __________________________________________          EE# or SSN: _________________________________
*Hire Date: _____/_____/_____      *Last Date of Employment: _____/_____/_____
*Manager Name: __________________________________          *Department: ______________________________

Tell Us Why You’re Leaving
We can’t improve upon what we don’t know. Providing information about why you chose to leave us is important feedback
that we take seriously. Check all the options below that describe why you are leaving. Be honest.
     Career advancement                                                                    My boss
     Better pay                                                                            To care for a child or family member
     Spouse/Partner relocation                                                             Starting my own business
     To care for my own medical condition                                                  Schedule
     Shorter commute                                                                       Work/life balance
     Company values/culture                                                                Management/Leadership
     Better benefits                                                                      Respect
     Co-workers                                                                            Lack of recognition
     Peruse education                                                                      Lack of training & development
     Other: _____________________________________________________________________________________________
If you want, share more details about the reasons you selected above. You can attach a separate sheet if you like.
Is the reason you’re leaving related to a problem at work (i.e. issue with manager, co-workers, fairness in treatment etc)?
No          Yes
If you answered “yes”, share the specific details of the problem.
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