Exit Interview Survey

1. Employee

Name

Title

Department

Email Address

2. Supervisor

Name

Title

Department

3. Why are you leaving [Company Name]?

Going back to School

Better Opportunity

Personal Reasons

Medical Benefits

Salary

Work Environment

Other: please specify

4. Please explain your reason(s) for leaving in more detail:

5. Would you recommend this company to your friends and family as a good place to work?

Yes

No

6. Please explain your reason(s) for recommending or not recommending:

Thank you!

Thank you for taking our survey. Your feedback is very important to us.