EXIT INTERVIEW QUESTIONNAIRE

This questionnaire and your scheduled exit interview are important elements
of our separation policy. Your assistance in this matter will be greatly
appreciated. As an opportunity to make a final contribution toward
improving areas of concern, your assistance is greatly appreciated. Please
be open and honest in order that we may better serve our associates in the
future.

Name: Date of Hire:

Department: Date of Separation:
Job Title: Supervisor:

1) What is (are) the primary reason(s) for leaving the Company?

1)
2)
3)
Comments

2) How long have you been considering your decision to leave the company

3) Please tell us the specific incident/event which has triggered your thought
process of leaving the company.
1.
2.

4) Have you ever discussed your dissatisfaction/grievance with anyone? If Yes, with
whom and when? Was there any attempt to mitigate your concern?

5) What could have been done to retain you as an associate

1.
2.

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7) How did each of the following influence your decision? Please respond by circling
one number below for each item.

Factors Affecting Decisive Very Important Not so

Separation Important important
A. Nature of
Work
B. Salary &
Benefits
C. Lack of Career
growth
opportunity
D. Immediate
Superior**
E. Organization
Culture (Speed
of decision
making, ethical
work behavior,
open
communication
etc.)
F. Hygiene Factor
(Designation,
Commuting
Distance, work
hours etc.)
G. Unfriendly
work
environment
H. Lack of Self
Development
opportunity
I. Lack of
professionalism
J. Insufficient
training to
perform the job
effectively
K. Not so clear
understanding
about roles and
responsibilities
L. Insufficient &
Infrequent
feedback on
work
performance
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** Please give a few specific examples to illustrate why you are leaving because of
your immediate superior.

8) What are the attributes, in your new assignment , you find more appealing
compared to your current job?(In case of multiple reasons, would you mind giving
priorities)

- Role/Job Nature
- Wage(by what percentage)
- Growth Opportunities :
- Designation:
- Location
- Any Other

9) What changes would you suggest for Company in India to make it a better place
to work for?
1.
2.

Exit Interviewer’s Signature: _____________________________

Date:_________________

Associates Signature: ___________________________________

Date:

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