Exit Interview Form Employee Exit Interview Form Date Date Format: MM slash DD slash YYYY NameLocation/DepartmentSupervisorHire DateTermination DateStarting PositionEnding PositionStarting SalaryEnding SalaryPART 1: REASONS FOR LEAVING More than one reason may be given if appropriate; if so, circle primary reason. RESIGNATION Took another position Pregnancy/home/family needs Poor health/physical disability Relocation to another city Travel difficulties To attend school Other (specify) Dissatisfaction with salary Dissatisfaction with type of work Dissatisfaction with supervisor Dissatisfaction with co-worker Dissatisfaction with working conditions Dissatisfaction with benefits LAID OFF Lack of work Abolition of position Lack of funds Other (specify) RETIREMENT Voluntary retirement Disability retirement Regular retirement Plans After LeavingPART 2: COMMENTS/SUGGESTIONS FOR IMPROVEMENT We are interested in what our employees have to say about their work experience with Mitec. Please complete this form. 1. What did you like most about your job?2. What did you like least about your job?3. How did you feel about the pay and benefits?Rate of pay for your jobPoorFairGoodExcellentRate of pay for your job Additional NotesPaid holidaysPoorFairGoodExcellentPaid Holidays Additional NotesPaid vacationsPoorFairGoodExcellentPaid Vacations Additional NotesRetirement planPoorFairGoodExcellentRetirement plan Additional NotesMedical coverage for selfPoorFairGoodExcellentMedical coverage for self Additional NotesMedical coverage for dependentsPoorFairGoodExcellentMedical coverage for dependents Additional NotesLife insurancePoorFairGoodExcellentLife insurance Additional NotesSick leavePoorFairGoodExcellentSick Leave Additional Notes4. How did you feel about the following:Opportunity to use your abilitiesVery DissatisfiedSlightly DissatisfiedNeutralSlightly SatisfiedVery SatisfiedOpportunity to use your abilities Additional NotesRecognition for the work you didVery DissatisfiedSlightly DissatisfiedNeutralSlightly SatisfiedVery SatisfiedRecognition for the work you did Additional NotesTraining you receivedVery DissatisfiedSlightly DissatisfiedNeutralSlightly SatisfiedVery SatisfiedTraining you received Additional NotesYour supervisor’s management methodsVery DissatisfiedSlightly DissatisfiedNeutralSlightly SatisfiedVery SatisfiedYour supervisor’s management methods Additional NotesThe opportunity to talk with your supervisorVery DissatisfiedSlightly DissatisfiedNeutralSlightly SatisfiedVery SatisfiedThe opportunity to talk with your supervisor Additional NotesThe information you received on policies, programs, projects and problemsVery DissatisfiedSlightly DissatisfiedNeutralSlightly SatisfiedVery SatisfiedThe information you received on policies, programs, projects and problems Additional NotesThe information you received on departmental structureVery DissatisfiedSlightly DissatisfiedNeutralSlightly SatisfiedVery SatisfiedThe information you received on departmental structure Additional NotesPromotion policies and practicesVery DissatisfiedSlightly DissatisfiedNeutralSlightly SatisfiedVery SatisfiedPromotion policies and practices Additional NotesDiscipline policies and practicesVery DissatisfiedSlightly DissatisfiedNeutralSlightly SatisfiedVery SatisfiedDiscipline policies and practices Additional NotesJob transfer policies and practicesVery DissatisfiedSlightly DissatisfiedNeutralSlightly SatisfiedVery SatisfiedJob transfer policies and practices Additional NotesOvertime policies and practicesVery DissatisfiedSlightly DissatisfiedNeutralSlightly SatisfiedVery SatisfiedOvertime policies and practices Additional NotesPerformance review policies and practicesVery DissatisfiedSlightly DissatisfiedNeutralSlightly SatisfiedVery SatisfiedPerformance review policies and practices Additional NotesPhysical working conditionsVery DissatisfiedSlightly DissatisfiedNeutralSlightly SatisfiedVery SatisfiedPhysical working conditions Additional NotesCOMMENTS5. a) If you are taking another job, what kind of work will you be doing?b) What has your new place of employment offered you that is more attractive than your present job?6. Could Mitec have made any improvements that might have influenced you to stay on the job?Other remarks (optional):Employee's SignatureDate Date Format: MM slash DD slash YYYY OFFICE USE ONLY. Discussed with employee Right to file for unemployment benefits Conversion of benefits If retiring, state option for payment of unused leave Interviewer's SignatureDate Date Format: MM slash DD slash YYYY
