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8/2/2019 Exit Sample 1
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Exit Interview FormatEmployee Name Emp code
Division Designation
Date of Joining Date of leaving
1. Reasons for leaving (Pls specify reasons in the box
below)
a) Work Related(i) Work Environment : Excellent / Very Good /
Good / Satisfactory / Poor
(ii) Job Satisfaction : Excellent / Very Good / Good /
Satisfactory / Poor
(iii) Support from your Immediate : Excellent / Very Good / Good
/ Satisfactory /Poor
Manager
(iv) Rapport with your colleagues : Excellent / Very Good / Good
/ Satisfactory / Poor
(v) Management Style : Courteous / Helpful / Problem Solving
(vi) Training Provided : Excellent / Very Good / Good /
Satisfactory / Poor
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8/2/2019 Exit Sample 1
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Exit Interview Format
(vii) Infrastructure Provided : Excellent / Very Good / Good /
Satisfactory / Poor
b) Better Prospectus (Pls specify reasons in the box below)
(i) What will be your current designation and Role ?
(ii) Are you taking up additional Responsibilities ?
(iii) Have you got a better compensation, if so how much?
(iv) Which platform are you going to work
(v) Have you received any overseas work opportunities? If so
which is the place of work.
(vi)Which is your field of interest? Are you planning for
further studies, if so, in which field.
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8/2/2019 Exit Sample 1
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Exit Interview Format(vii) Are you planning to relocate, if so
to which place?
Personal Reason (Pls specify reasons in the box below)
Financial Constraint
Relocation to Home town
Further Studies
Better work Atmosphere
Marriage
Family Problem
2. What circumstances would have prevented your departure?
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8/2/2019 Exit Sample 1
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Exit Interview Format
(Pls specify reasons in the box below)
Better Work atmosphere
Better guidance and Support from your supervisor
Better employee interaction
Additional support from the management
Better Compensation and Benefit
Additional roles and Responsibilities
Additional Employee benefits
Advanced Training in your field
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8/2/2019 Exit Sample 1
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Exit Interview Format3. What did you like most about your
job?
4. What did you like least about your job?
5. What did you think of your supervisor on the following
points?
Almost Always Usually SometimesNever
Was consistently fair ( ) ( ) ( )( )
Provided recognition ( ) ( ) ( )( )
Resolved complaints ( ) ( ) ( )( )
Was sensitive to employees needs ( ) ( ) ( )( )
Provided feedback on performance ( ) ( ) ( )( )
Was receptive to open communication ( ) ( ) ( )( )
6. How would you rate the following?Excellent Good Fair Poor
Cooperation within your division/program ( ) ( ) ( )( )
Cooperation with other divisions ( ) ( ) ( )( )
Personal job training ( ) ( ) ( )( )
Equipment provided (materials, resources, facilities) ( ) ( ) (
)( )
Companys performance review system ( ) ( ) ( )( )
Companys new employee orientation program ( ) ( ) ( )( )
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8/2/2019 Exit Sample 1
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Exit Interview FormatRate of pay for your job ( ) ( ) ( )
( )
Career development/Advancement opportunities ( ) ( ) ( )( )
Physical working conditions ( ) ( ) ( )( )
7. Was the work you were doing approximately what you expected
it would be?
Yes No
8. Was your workload usually:
Too heavy ( ) About right ( ) Too light ( )
9. How did you feel about the employee benefits provided by the
company?
Excellent Good Fair Poor No Opinion( ) ( ) ( ) ( ) ( )
10. Would you recommend the company to a friend as a good
organization to work for?
Most definitely ( ) with reservations ( ) No ( )
. What suggestions do you have to make xxx a
better place to work ?
2. Are you open to the idea for re-joining xxx at a
future date ?
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8/2/2019 Exit Sample 1
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Exit Interview Format
Summary of Interview
Human Resources Representative Employee
