HTML Preview Generic Exit Interview Form page number 1.
EXIT INTERVIEW QUESTIONNAIRE
Please complete and return to Human Resources prior to your date of leaving or as soon as possible
afterwards. This will allow us to identify whether any improvements/adjustments can be made for the future.
The information will be used for monitoring purposes. However, we may wish to contact you to discuss certain
aspects of the questionnaire.
Please tick if you do not wish to be contacted.
Have you been offered the opportunity of an exit interview with your line manager? YES NO
Some information about you
Name ……………………………… Department ………………………………
Post ……………………………… Full-time Part-time Permanent Temporary
Male Female Age: Under 25 25-34 35-44 45-54 55-64 Over 64
Ethnic Origin:
White Black, Black Scottish Mixed
Or Black British
Scottish Caribbean
Other British African (Any mixed Background)
Irish Any other
Any other
Please Specify ……………….. Please Specify ……………….. Please Specify ………………..
Asian, Asian Scottish Other Ethnic Background
Or Asian British
Indian
Pakistani
Bangladeshi
Chinese
Any other
Please Specify ……………….. Please Specify ………………..
Do you consider yourself to have a disability? Yes No
Date of Leaving ………………..………………..………………..………………..
Length of Service with the University ………………..………..…………………
Length of time in current post ………………..………..………………………….
Current Salary ………………..………..…………………………………..……….
P.T.O