EXIT INTERVIEW TEMPLATE

EMPLOYEE NAME	CONDUCTED BY
EMPLOYEE START DATE	EMPLOYEE END DATE	EXIT INTERVIEW DATE
POSITION TITLE	POSITION DEPARTMENT

At what point in time did you begin considering leaving your current position?
Please indicate all applicable contributing factors to your decision to resign. If “Other,” please explain.
SALARY	JOB ADVANCEMENT	PERSONAL
FURTHERING EDUCATION	RELOCATION	HEALTH RETIREMENT
FAMILY RESPONSIBILITIES	DISSATISFIED / MANAGEMENT	BENEFITS
JOB ELIMINATED	MILITARY	OTHER please explain in space below
Was your resignation prompted by a specific event or issue? If yes, please explain.
If a specific event prompted your resignation, was the matter discussed with your manager and/or HR? If yes, please explain.
Did you encounter any problems while maintaining your current position? If yes, please explain.
What did you find enjoyable about your work experience?
What did you find least enjoyable about your work experience?
Would you recommend our company as a potential employer to others? Please explain why or why not.
Based upon your experience, would you be open to reapplying to future opportunities with our company? Please explain.

Please complete the following evaluation based upon your experiences with the company.

N/A	POOR	FAIR	GOOD	EXCELLENT	COMMENTS
Amount of training provided
Quality of training provided
Working relationship with manager
Working relationship with teammates
Working relationship with other departments
Satisfaction with level of compensation / salary
Satisfaction with employee benefits
Company’s position on work / life balance
Overall workload
Overall satisfaction
N/A	POOR	FAIR	GOOD	EXCELLENT
TOTALS

Provide any additional comments you wish to share. Thank you.

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