Company Name

EXIT INTERVIEW FORM

Your departure from XXXXXXXX Pvt. Ltd will indeed be a great loss to us. We would,

however take this opportunity to understand from you the good practices we have and

also gaps in our existing systems and processes and try to further improve upon them.

Your feedback is extremely important to us and we would be grateful for your feedback

and frank comments on the issues as mentioned hereunder:

To be filled in by HR Department :

Employee's Name In Full: ________________________________________________

Employee No:______________________ Gross Salary: _______________________

Designation on leaving: __________________________________________________

Date Of Joining: ____________________ Date Resigned: ____________

Last Day Of Work: __________________ Date Interviewed: __________

Interviewed By: _____________________

1. How would you rate XXXXXXX Pvt .Ltd as a MODEL employer (please tick one)Excellent Good Average Poor

2. Please mention 3 things you like best about XXXX.a. ____________________________________________________________b. ____________________________________________________________c. ____________________________________________________________

3. Please mention 3 things you do not like about XXXX.a. ____________________________________________________________b. ___________________________________________________________c. ____________________________________________________________

Designed & Drafted By: HR

4. What is/are the reason(s) of you are leaving XXX?

Your Reasons for leaving Tick MarkHigher salaryHigher studies Dissatisfaction with the job contentLack of role clarityNot very good relationships with the peers / superior / subordinatesLack of Infrastructure Lack of Developmental OpportunitiesPoor Work CultureLeadership styles of SuperiorsShifting to the industryAny other (please specify)

5. Rating of BTM: (Please tick Mark )Excellent Good Fair Poor

Company BenefitsSalaryWorking ConditionsAdvancement/Training OpportunityOthersOverall Rating

6. How would you describe communication? (Please tick Mark )Excellent Good Fair Poor

Throughout the company:Between managers and staff:Between departments:Within your department:

7. How, in your opinion, the next assignment is going to add value to your career?________________________________________________________________________________________________________________________________________________________________________________________________

8. Would you recommend your friends to join XXXX? Please give reasons.________________________________________________________________________________________________________________________________________________________________________________________________

Designed & Drafted By: HR

9. Would you re-join BTM, if given an offer in future? If yes, on what terms?_________________________________________________________________________________________________________________________________________________________________________________________________________

10. Please complete the following by ticking one of the 4 boxes:-

Strongly Agree

Agree Disagree Strongly Disagree

- My orientation to the job was effective.- My skills have been used effectively.- I was provided all useful information, on

time.- My work schedule met my professional

needs.- I was given opportunities to grow (career

advancement)- I had a clear understanding of the tasks and

expectations - I had the opportunity to work on different

and/ or latest technologies- My Job training was adequate.

11. Please give suggestions to develop XXXX.________________________________________________________________________________________________________________________________________________________________________________________________

Employee Signature: Date: __________________

Thank you for your co-operation

Signature of HR Head:

Remarks if any:

Designed & Drafted By: HR