Employee Exit Interview Questionnaire Template

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EMPLOYEE EXIT INTERVIEW QUESTIONNAIRE
Interviewer :
Date_________________________
Employee=s Name_________________________________
Social Security #___________________ Phone Number (
)____________________
Sponsor
_________________________________________________
Employee=s Supervisor_______________________________________
Related Class School Attended
________________________________________________________
WHAT IS YOUR MOST SIGNIFICANT REASON(S) FOR LEAVING (circle)
Better Opportunity
Maternity
No Health Benefits
Better Compensation
Marriage
Economics Reasons (Check)
Child Care ___
Better Working Conditions
Relocation
Cost of School ___
Lack of Work ___
Lack of Training OJT/School Military
Parking Fees ___
Job Lay-off
Health Issues
Poor Supervision
Co-Workers
Termination
Transportation Problems
******************************************************************************
Over Please
EMPLOYEE EXIT INTERVIEW QUESTIONNAIRE
Interviewer :
Date_________________________
Employee=s Name_________________________________
Social Security #___________________ Phone Number (
)____________________
Sponsor
_________________________________________________
Employee=s Supervisor_______________________________________
Related Class School Attended
________________________________________________________
WHAT IS YOUR MOST SIGNIFICANT REASON(S) FOR LEAVING (circle)
Better Opportunity
Maternity
No Health Benefits
Better Compensation
Marriage
Economics Reasons (Check)
Child Care ___
Better Working Conditions
Relocation
Cost of School ___
Lack of Work ___
Lack of Training OJT/School Military
Parking Fees ___
Job Lay-off
Health Issues
Poor Supervision
Co-Workers
Termination
Transportation Problems
******************************************************************************
Over Please
Dates of Employment From_________________ To ___________________
Year Participant Left Program
1
2
3
4
5
SPECIFIC REASONS, OTHER THAN ABOVE, WHICH CAUSED
YOU TO LEAVE _________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
********************************************************************
For In-House Use Only :
Sex : M
F
Veteran : Vietnam Era
Other Veteran
Non- Veteran
Ethnic : White
Disabled : Yes
Black
No
Hispanic
Am. Indian or Alaskan Native
Asian or Pacific Islander
Highest Schooling Completed :
Other
12
GED
College 13, 14, 15, 16

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