Company Name

EXIT INTERVIEW FORM

Your departure from XXXXXXXX Pvt. Ltd will indeed be a great loss to
us. We would, however take this opportunity to understand from you
the good practices we have and also gaps in our existing systems and
processes and try to further improve upon them.

Your feedback is

extremely important to us and we would be grateful for your feedback

and frank comments on the issues as mentioned hereunder:
To be filled in by HR Department :

Employee's Name In Full: ________________________________________________

Employee No:______________________

Gross Salary: _______________________

Designation on leaving: __________________________________________________

Date
Of
____________________
Last
Day
__________________
Interviewed
_____________________

1.

Of

Work: Date Interviewed: __________

By:

How would you rate XXXXXXX Pvt .Ltd as a MODEL employer

(please tick one)
Excellent
Good
Average
Poor

2.

Please mention 3 things you like best about XXXX.

____________________________________________________________
____________________________________________________________
____________________________________________________________

3.

Please mention 3 things you do not like about XXXX.

____________________________________________________________
___________________________________________________________

a.
b.
c.
a.
b.

Joining: Date Resigned: ____________

Designed & Drafted By: HR

c.

____________________________________________________________

4.

What is/are the reason(s) of you are leaving XXX?

Your Reasons for leaving

Tick
Mark

Higher salary
Higher studies
Dissatisfaction with the job content
Lack of role clarity
Not very good relationships with the peers / superior /
subordinates
Lack of Infrastructure
Lack of Developmental Opportunities
Poor Work Culture
Leadership styles of Superiors
Shifting to the industry
Any other (please specify)
5. Rating of BTM: (Please tick Mark )
Excellent
Company Benefits
Salary
Working Conditions
Advancement/Training Opportunity
Others
Overall Rating

Good

Fair

6. How would you describe communication? (Please tick Mark )

Excellent
Good
Fair
Throughout the company:
Between managers and staff:
Between departments:
Within your department:
7.

How, in your opinion, the next assignment is going to add value

to your career?
________________________________________________________________
________________________________________________________________
________________________________________________________________

Designed & Drafted By: HR

Poor

Poor

8.

Would you recommend your friends to join XXXX? Please give

reasons.
________________________________________________________________
________________________________________________________________
________________________________________________________________

9.

Would you re-join BTM, if given an offer in future? If yes, on what

terms?
_____________________________________________________________________
__________________________________________________________________
__________________________________________________________________

10.

Please complete the following by ticking one of the 4 boxes:Strongl Agr

y Agree ee

Disag
ree

Stron
gly
Disag
ree

- My orientation to the job was

effective.
- My skills have been used
effectively.
- I was provided all useful
information, on time.
- My work schedule met my
professional needs.
- I was given opportunities to grow
(career advancement)
- I had a clear understanding of the
tasks and expectations
- I had the opportunity to work on
different and/ or latest
technologies
- My Job training was adequate.
11. Please give suggestions to develop XXXX.
________________________________________________________________
________________________________________________________________
________________________________________________________________

Designed & Drafted By: HR

Employee Signature:
__________________

Date:

Thank you for your co-operation

Signature of HR Head:
Remarks if any:

Designed & Drafted By: HR