Highly Confidential
1.1 – Personal details of exiting employee
Name Fill in details
Designation Fill in details
Joining Date Fill in details
Relieving Date Fill in details
Location Fill in details Reporting Manger Fill in details
1.2 – Reason for exit. Use the check box to indicate
Career Growth Compensation Compensation Personal
Org. Policies Mgmt. Issues Education Relocation
Additional Comments, if any:
1.3 – Please indicate your experience with the following:
Job Related Factors Good Averagee Poor Bad
Challenges & satisfaction in the job
Resources & Information to perform Job
Recognition of efforts
New learning experiences
Reporting manager’s behaviour
Relationship with team members
Training and development opportunities
Salary & Benefits Offered
Teamwork
Growth opportunities
Additional Comments, if any:
1.4 – Kindly suggest improvements that in your view can help the organization to grow
Additional Comments, if any:
Name of interviewer: Fill in details
Date and Signature of interviewer: