Form - Exit Interview
Form - Exit Interview
Form - Exit Interview
(To be completed by resigning employee. Please submit the accomplished form to Employee Relations prior to Exit Interview.)
Thank you complying with our exit requirements. The EMPLOYEE EXIT QUESTIONNAIRE & the EXIT INTERVIEW was developed to obtain
information from departing employees concerning their experiences with the Company. This will assist us in evaluating our current policies &
procedures. Please take a few minutes to complete the Employee Exit Form and submit the form before your scheduled Exit Interview with
Employee Relations. Please be assured all your information will be treated with great confidentiality.
Instructions: Kindly answer the following questions honestly. Your responses will help us evaluate and identify the areas for improvement in the
organization so that necessary interventions may be instituted.
I. Personal Information
a. Age: _________________________
e. Educational Attainment:
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College Undergraduate College Graduate 2 Year Course
____________________________________________________________________________________
____________________________________________________________________________________
Step 1. Please check the reason which best applies to you. If you have more than 1 reason for leaving, choose the top 3 reasons and rank them
accordingly (with 1 as the primary reason). Mark your answer in the boxes provided.
Step 2. Then, to elaborate on the details of your separation, kindly mark the circles after your selected reason/s and indicate your other
responses in the spaces provided (if applicable).
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a. Name of the Company: ____________________________________
b. Location
Local Abroad -- Please indicate destination:_______________________
d. Position Title:_______________________________
higher position; same salary same position; higher salary career alignment
higher position; higher salary different position; same salary career shift
same position; same salary different position; higher salary
g. Reasons for joining another company/ looking for other employment: _______________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Further Education
Review for Board Exam Masters or Doctorate Degree Finish Bachelor’s Degree
Will take another Bachelor Degree Short-term Course
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Health Reasons (please specify): ____________________________________________________________
V. Assess the degree of effectiveness of the following items by choosing the number that corresponds to your response. Your
suggestions will help in the continuous improvement of the Company’s working conditions, superior-subordinate working
relationships, employee programs and HR Services.
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you have attended/participated in:
a. _____________________________
b. _____________________________
c. _____________________________
a. To the best of your knowledge, do you have any outstanding or unresolved employment-related grievances or claims against
INFOCOM?
Yes None
b. If there was anything that would have prevented your resignation, what would it have been? ____________________
___________________________________________________________________________________
d. Would recommend INFOCOM to others as a good place to work? Why or why not?
Yes None
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g. What changes would you recommend we make? ______________________________________________________
____________________________________________________________________________________
i. How would you describe your feelings about your team or department? _____________________________________
____________________________________________________________________________________
j. How would you describe your Immediate Supervisor and your Manager? ____________________________________
____________________________________________________________________________________
k. From the list below, please rank your top 3 reasons for leaving (1 being the highest):
Interviewer’s Notes:
***Nothing Follows***
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