Employee Exit Interview Form
Employee Name
Date of Interview:
Last Day of Employment: DEPARTMENT:
I would appreciate it if you would take a few minutes to respond to the questions below.
All answers will be held in strict confidence. Thank you.
How long were you employed? Job Title?
Why are you leaving?
If moving, need forwarding address for tax documentation, cobra, etc.
Would you describe your working relationship (with respect to both your particular job and your
relationship with fellow workers) as pleasant or unpleasant? What did you like least about working
here? What did you like about working here?
Do you feel that your particular job was important and significant in the overall operation of the
business? Do you feel you were treated fairly while at the University?
How did you feel about your chances for advancement?
Is there any problem that you know about (or heard) concerning the University?
Are there any particular or working conditions that either led to your decision to resign or that you feel
are detrimental to a satisfactory working relationship? If so, have you any suggestions on how to
eliminate them?
Are there any particular practices or working conditions that you feel are particularly beneficial to an
effective working relationship and that should be maintained? What changes would have to take place for
you to come back?
Rate your In charge on the following:
Always Usually Sometimes Never
Follow policies &
procedures
Treats employees in a fair
and equal way
Provides recognition for a
job well done
Resolves complaints and
problems
Gives needed information
Keeps employees busy
Knows his/her job well
Welcomes suggestions
Maintains discipline
What do you think of the following in your department?
Excellent Good Fair Poor
Cooperation/teamwork in the
department
Cooperation with other
departments
Department training
Communications
Working Conditions
Work Schedule
How do you feel about the following?
Excellent Good Fair Poor
Rate of Pay for your job
Amount of paid leave accrual
Health Insurance program
Clearance Information (To be completed by HR)
Written Resignation
Keys Other
ID/ Badge
Personnel Release form turned in
ACKNOWLEDGEMENT OF CORPORATE COMPLIANCE RESPONSIBILITIES
I have no knowledge of any violation of the law or any corporate policies or standards of
conduct by me or any other employees while I have been employed at the University. If I recall
any suspected violations in the future, I will immediately report them to the Compliance Officer.
Would you care to make any other comments?
Signed: Date:
