EXIT INTERVIEW FORM
Annexure-A
Employee Name: Designation:
Employee No: Region/Dept
Personal Email: Contact No:
Reasons for Leaving
Please share if any of the mentioned below is your primary reason of leaving the organization?
Salary Better Career Prospect Office Location Supervisor
Benefits Nature of Work Higher Education Work Life Balance
Others: __________________
Factors at OBS that have influenced your decision to leave the company or that have attracted you to make
a career move.
Please rate the following factors according to their influence / impact on your decision to leave as per below
scale
Rating Scale: 5- Major Influence, 4- Substantial Influence, 3-Average Influence, 2- Minor Influence, 1-No
Influence
Factor Rating
Compensation / salary at Aspin 1 2 3 4 5
Benefits offered at Aspin 1 2 3 4 5
Relationship with immediate supervisor 1 2 3 4 5
Appreciation against efforts / Recognition of 1 2 3 4 5
achievement / Honest performance feedback
Empowerment at Aspin 1 2 3 4 5
Understanding / Knowledge strategic direction of 1 2 3 4 5
Leadership
Lack of challenging assignments 1 2 3 4 5
Inconvenient office location 1 2 3 4 5
Aspin as employer brand 1 2 3 4 5
Poor fit of skills/interests with current job 1 2 3 4 5
Immediate promotion opportunities 1 2 3 4 5
Long term career progression opportunities 1 2 3 4 5
Formal training opportunities at Aspin 1 2 3 4 5
On job development / mentoring opportunities at 1 2 3 4 5
Aspin
Dissatisfaction with Annual Performance 1 2 3 4 5
Appraisal
Dissatisfaction with work-life balance 1 2 3 4 5
Job security concern 1 2 3 4 5
Other [please state]: 1 2 3 4 5
New Organization
You are requested to share the following information. The information provided will be treated as
confidential. We appreciate your response, however it is not mandatory.
Organization Name: Industry:
New Position: New Salary:
New Benefits:
If given an opportunity, what would you like to change at Aspin? Please mention any three.
1. ____________________ 2. ____________________ 3. ____________________
Would you recommend Aspin to a friend / family as a good place to work?
Yes No
If given an opportunity, will you, prefer to be part of Aspin again?
Yes No
Other Comments
__________________ __________________ __________________
Date Interviewer Name Date & Signature