EXIT INTERVIEW FORM
Objective:
This questionnaire is intended to gain feedback from resigning employees
regarding their views towards the Company and their tenure of service. This
information will help the Company in handling problems in lieu with the
Companys aim of being a respected organization.
We hope that you could give your co-operation in answering the questionnaire
sincerely.
Name:
_________________________________________________________________________________
Company: ___________________________ Department:
___________________________________
Date Joined: _____________ Date Resigned: ________________ Grade/Salary
_______________
Instruction: Please tick (X) where applicable
1. What made you interested in joining this Company initially?
___________________________________________________________________________________
___________________________________________________________________________________
2. Please state the reason for your resignation (You may tick more than one).
[ ] Challenges with work
[ ] Challenges with Management
[ ] Challenges with the HOD/Supervisor
[ ] Challenges with colleagues
[ ] Others :
3. Please suggest on how the Management could improve; with details of areas and
reasons.
____________________________________________________________________________________
4. Do you think this Company is a good place to work in?
[ ] Yes [ ] No
State reasons:
________________________________________________________________________
_________________________________________________________________________________
__
5. Other comments:
_____________________________________________________________________
_________________________________________________________________________________
__
Signature: _________________________________ Date:
_________________________________
FOR OFFICE USE
Interviewers Comment:
_______________________________________________________________________________________
_______________________________________________________________________________________
Signature: _________________________________ Date:
___________________________________
CLEARANCE WITH ACCOUNTS DEPARTMENT
a) Personal loan : Balance: _____________
b) Housing loan: Balance: _____________
c) Club membership: Card returned: Yes / No Remarks: __________
d) Other advance: Balance: _____________ Remarks: __________
Signature: ___________________________ Date: __________________________________
(Accounts Department)
I declare that all the above process has been completed.
Employee Signature: ____________________ Date : ___________________________
FOR HR DEPT
Checked Cleared File
HR Manager Signature : __________________ Date : ___________________________