EXIT INTERVIEW FORM

Objective:
This questionnaire is intended to gain feedback from resigning employees
regarding their views towards the Company and their tenure of service. This
information will help the Company in handling problems in lieu with the
Companys aim of being a respected organization.

We hope that you could give your co-operation in answering the questionnaire
sincerely.

Name:

_________________________________________________________________________________

Company: ___________________________ Department:

___________________________________

Date Joined: _____________ Date Resigned: ________________ Grade/Salary

_______________

Instruction: Please tick (X) where applicable

1. What made you interested in joining this Company initially?

___________________________________________________________________________________

___________________________________________________________________________________

2. Please state the reason for your resignation (You may tick more than one).

[ ] Challenges with work

[ ] Challenges with Management
[ ] Challenges with the HOD/Supervisor
[ ] Challenges with colleagues
[ ] Others :

3. Please suggest on how the Management could improve; with details of areas and
reasons.

____________________________________________________________________________________

4. Do you think this Company is a good place to work in?

[ ] Yes [ ] No

State reasons:
________________________________________________________________________

_________________________________________________________________________________
__
5. Other comments:
_____________________________________________________________________

_________________________________________________________________________________
__

Signature: _________________________________ Date:

_________________________________
FOR OFFICE USE

Interviewers Comment:

_______________________________________________________________________________________

_______________________________________________________________________________________

Signature: _________________________________ Date:

___________________________________

CLEARANCE WITH ACCOUNTS DEPARTMENT

a) Personal loan : Balance: _____________

b) Housing loan: Balance: _____________

c) Club membership: Card returned: Yes / No Remarks: __________

d) Other advance: Balance: _____________ Remarks: __________

Signature: ___________________________ Date: __________________________________

(Accounts Department)

I declare that all the above process has been completed.

Employee Signature: ____________________ Date : ___________________________

FOR HR DEPT

Checked Cleared File

HR Manager Signature : __________________ Date : ___________________________