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Exit Interview Form Template

The document is an exit interview form for employees leaving a company, capturing essential details such as the employee's name, position, reasons for leaving, and employer's reasons for dismissal. It includes a rating scale for evaluating the employee's performance, attendance, loyalty, conduct, initiative, and intelligence. Additionally, it contains a disclaimer regarding the accuracy and reliability of the information provided.

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kawsar02
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8 views2 pages

Exit Interview Form Template

The document is an exit interview form for employees leaving a company, capturing essential details such as the employee's name, position, reasons for leaving, and employer's reasons for dismissal. It includes a rating scale for evaluating the employee's performance, attendance, loyalty, conduct, initiative, and intelligence. Additionally, it contains a disclaimer regarding the accuracy and reliability of the information provided.

Uploaded by

kawsar02
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

[INSERT LOGO HERE]

COMPANY NAME

EXIT INTERVIEW

Name: Position Title:

Start Date: Leaving Date:

Salary on Leaving: Form completed by:

Reasons given for leaving are: (tick as appropriate)

1. Insufficient Pay □ 6. Domestic problems □


2. Poor working conditions □ 7. Poor health □
3. No job satisfaction □ 8. Transport problems □
4. Lack of promotion □ 9. Personal conflicts □
5. Lack of training □ 10. Other reasons □

Comments

Employer’s reason for dismissal (tick as appropriate). Enter further details on the back of this form if necessary

1. Capability □ 5. Redundancy □
2. Misconduct □ 6. Statutory ban □
3. Gross misconduct □ 7. Some other substantial reason □
4. Retirement □
[INSERT LOGO HERE]
Short notes for future reference about the employee. Grade on a scale of 1 (low) to 5 (high)

Ability/performance 1 2 3 4 5

Attendance/timekeeping 1 2 3 4 5

Loyalty/co-operation 1 2 3 4 5

Conduct 1 2 3 4 5

Initiative 1 2 3 4 5

Intelligence 1 2 3 4 5

Honest Yes □ No □ Would you re-employ Yes □ No □

Any other comments

Signature:

Date:

This document is for general information purposes only. While we endeavour to keep the information up to date and
correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy,
reliability, or suitability with respect to the content of this document.

In no event will we be liable for any loss or damage including without limitation, indirect or consequential loss or damage,
or any loss or damage whatsoever arising from the use of the documents.

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