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TOOL Abbreviated Exit Interview Questionnaire

April 11, 2000
You can use the following short questionnaire in conjunction with an exit interview conducted on-site. The following is just an example.

 

EXIT INTERVIEW

As a resigning associate of _______________, you can be a valuable source of information regarding various working conditions observed during your period of employment.

Please be assured that your questionnaire will not become a part of your permanent personnel record file, and your comments will in no way affect your re-employment possibilities should you desire to seek employment again with _______________.

We are striving to maintain a positive working environment and hope that your suggestions, comments and observations will aid us in accomplishing this goal.

 

ASSOCIATE S NAME (OPTIONAL):
_________________________

Resignation Date:

_______________

Hire Date:

_______________

Job Title:

_______________

Location:

_______________

 

(PLEASE PLACE AN "X" BESIDE YOUR REASON FOR LEAVING.)

REASON FOR LEAVING: (Mark as many as apply)

_____ 1. Secured a different job

_____ 2. Dissatisfied with pay

_____ 3. Moving from area

_____ 4. Family circumstances

_____ 5. Health reasons

_____ 6. Dissatisfied with type of work

_____ 7. Other (please explain)

 

 

 

 

(PLEASE RATE THE FOLLOWING FROM 1 TO 10 -- WITH 10 BEING THE BEST)

Training received

1

2

3

4

5

6

7

8

9

10

Comments


Company benefits

1

2

3

4

5

6

7

8

9

10

Comments


Career opportunities

1

2

3

4

5

6

7

8

9

10

Comments


Supervision received

1

2

3

4

5

6

7

8

9

10

Comments


Working conditions

1

2

3

4

5

6

7

8

9

10

Comments


Pay for work required

1

2

3

4

5

6

7

8

9

10

Comments


Type of work performed

1

2

3

4

5

6

7

8

9

10

Comments


The job met my expectations

1

2

3

4

5

6

7

8

9

10

Comments


The company s commitment to customer service

1

2

3

4

5

6

7

8

9

10

Comments


 

Please provide any additional information you feel will help _______________ exceed customers' expectations, attract and retain excellent employees.

 

 

 

 

 

SOURCE: Mike Smith, P.O. Box 1692 Wal, NJ 07719, ms@mikesmith-hr.com

The information contained in this article is intended to provide useful information on the topic covered, but should not be construed as legal advice or a legal opinion.