EXIT INTERVIEW FORM
Page 1
Effective 11 January 2024
Revised 1 February 2024
Employee Name
:
Nama Karyawan
Interviewer Name
:
Nama Penginterviu
Date of Interview
:
Tanggal Interviu
Join Date
:
Tanggal Bergabung
Exit Date
:
Tanggal Keluar
Starting Position
:
Posisi Awal Bekerja
Ending Position
:
Posisi Terakhir Bekerja
Superior Name
:
Nama Atasan
Department/ Division
:
Departemen/ Divisi
Reason for Leaving
Alasan Berhenti
*Give a checklist (√) ; more than one reason may be given if appropriate; if so, circle the primary reason
* Berikan tanda ceklis (√); lebih dari satu alasan bisa dilakukan jika perlu; beri tanda lingkaran pada
alasan utama.
Resignation (Pengunduran Diri)
Took another position Dissatisfaction with salary
(Menerima tawaran lain) (Tidak puas dengan gaji)
Marriage/ Pregnancy/ Family needs Dissatisfaction with type of work
(Pernikahan/Kehamilan/Tuntutan Keluarga) (Tidak puas dengan jenis pekerjaan)
Poor health/ physical disability Dissatisfaction with superior
(Masalah kesehatan) (Tidak puas dengan atasan)
Travel difficulties Dissatisfaction with co-workers
(Masalah jarak) (Tidak puas dengan rekan kerja)
To attend school Dissatisfaction with working conditions
(Untuk melanjutkan pendidikan) (Tidak puas dengan kondisi kerja)
EXIT INTERVIEW FORM
Relocation to another city/country Dissatisfaction with benefits or facility
(Pindah ke kota lain/negara lain) (Tidak puas dengan tunjangan/fasilitas)
_______ Other / Lainnya (specify) ________________________________________________________
Laid Off (Diberhentikan) • Retirement (Pensiun)
Lack of work Voluntary retirement
(Kurangnya pekerjaan) (Pensiun sukarela)
Abolition of position Disability retirement
(Penghapusan Posisi) (Pensiun karena disabilitas)
Lack of funds Regular retirement
(Kurangnya dana) (Pensiun regular)
________ Other (specify) ______________________________________________________________
Page 2
List of Questions
Daftar Pertanyaan
1 What is your primary reason for leaving? If multiple, please specify (including the new company
name and your position there).
Apa yang menyebabkan Anda keluar? Jika banyak, sebutkan secara rinci (termasuk nama
perusahaan dan posisi baru Anda disana).
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
2 When did you begin looking for another job?
Kapan anda mulai mencari pekerjaan baru?
________________________________________________________________________________
________________________________________________________________________________
3 What did you find the most satisfying about your job or the company?
Menurut Anda apa yang paling memuaskan dalam pekerjaan anda atau di dalam perusahaan ini?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
4 What did you find the most unsatisfying about your job or company?
Menurut Anda apa yang paling tidak memuaskan dalam pekerjaan anda atau di dalam perusahaan
ini?
EXIT INTERVIEW FORM
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
5 What benefits or programs did you feel were missing from the company?
Apakah ada tunjangan/fasilitas/program yang hilang/tidak ada di perusahaan ini?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Page 3
6 Do you have any suggestions how the company can improve job satisfaction for their employee
specifically for your position?
Apakah Anda memiliki saran untuk bagaimana perusahaan dapat meningkatkan kepuasan
karyawannya terutama untuk posisi Anda?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
7 Would you recommend this company to a colleague or friend as a good place to work?
Maukah anda merekomendasikan perusahaan ini kepada rekan kerja atau teman sebagai tempat
kerja yang baik?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
8 Is there anything that the company or your superior could have done to prevent you from leaving?
Apakah ada sesuatu yang dapat dilakukan manajer perusahaan atau manajer Anda untuk
mencegah Anda pergi?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
9 Would you consider returning to work for this company in the future?
Apakah Anda mempertimbangkan untuk kembali bekerja pada perusahaan ini di masa yang akan
datang?
_______________________________________________________________________________
_______________________________________________________________________________
EXIT INTERVIEW FORM
_______________________________________________________________________________
_______________________________________________________________________________
10 Do you have any other comments or suggestions?
Apakah Anda memiliki komentar atau saran lainnya?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________