[EMPLOYER NAME]EMPLOYEE EXIT INTERVIEW FORM

EMPLOYEE INFORMATION

Employee Name: [EMPLOYEE NAME] Title/Department: [JOB TITLE/DEPARTMENT]
Start Date With Company: [MM/DD/YYYY] Separation Date: [MM/DD/YYYY]

EXIT INTERVIEW QUESTIONNAIRE

Please describe why you are leaving your position.
[DESCRIBE WHY EMPLOYEE IS LEAVING]

Was your job what you expected it to be? ☐ Yes ☐ No
If not, please explain: [EXPLAIN JOB EXPECTATIONS]

Do you feel you were placed in a position compatible with your skills? ☐ Yes ☐ No
If not, please explain: [EXPLAIN SKILL COMPATIBILITY]

Do you feel that there was a possibility for advancement? ☐ Yes ☐ No
If not, please explain: [EXPLAIN PREVENTION OF POSSIBILITY]

What were some challenges you faced in your position?
[DESCRIBE CHALLENGES]

What did you like about your position?
[DESCRIBE POSITIVE JOB ASPECTS]

What did you dislike about your position?
[DESCRIBE JOB DISLIKES]

Is there anything the company could have done differently to change your decision?
[DESCRIBE WHAT COMPANY COULD HAVE DONE]

Additional Comments:
[ADDITIONAL COMMENTS]

EMPLOYEE SIGNATURE

Employee Signature:                                                           Date:
Print Name: [EMPLOYEE NAME]