HTML Preview Confidential Exit Interview page number 1.
08/24/10
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CONFIDENTIAL
EMPLOYEE EXIT INTERVIEW FORM
Date:
Name:
Security Social Number:
Location/Department:
Supervisor:
Hire Date:
Termination Date:
Starting Position:
Ending Position:
Starting Salary:
Ending Salary:
PART l: REASONS FOR LEAVING
More than one reason may be given if appropriate; if so, circle primary reason.
RESIGNATION
Took another position
Dissatisfaction with salary
Pregnancy/home/family needs
Dissatisfaction with type of work
Poor health/physical disability
Dissatisfaction with supervisor
Relocation to another city
Dissatisfaction with co-workers
Travel difficulties
Dissatisfaction with working conditions
To attend school
Dissatisfaction with benefits
Other (specify)
LAID OFF RETIREMENT
Lack of work
Voluntary retirement
Abolition of position
Disability retirement
Lack of funds
Regular retirement
Other (specify)
Plans After Leaving