[Company Name]

Exit Interview

Your opinion is important to us. Additional comments and suggestions are encouraged.

Name (optional)	Department
Supervisor (optional)	Position

1	Why are you leaving the company?	Choose an item.
2	Please explain your reason(s) for leaving in more detail. [Click here to enter text.]
3	What suggestions for improvement do you have for us? [Click here to enter text.]
4	If we implemented those suggestions, would you return to work here?	Choose an item.
5	Would you recommend this company to your friends as a good place to work?	Choose an item.
6	I believe that I was treated like a valuable member of the company.	Choose an item.
7	My immediate supervisor let me know when I was doing a good job.	Choose an item.
8	I felt free to suggest to my supervisor changes that would improve my department.	Choose an item.
9	My job duties and responsibilities were clearly defined.	Choose an item.
10	I received the proper training in order to perform my job effectively.	Choose an item.
11	Employee problems and complaints were resolved fairly and promptly in my department.	Choose an item.
12	If I had questions or concerns, I felt comfortable speaking with:
My immediate supervisor	Choose an item.
Upper management	Choose an item.
Human resources	Choose an item.
13	I was kept well informed about the company, its policies and procedures, and other important information.	Choose an item.
14	I felt that the company provided me with job security.	Choose an item.
15	Please rate the benefits that you received at the company (keeping in mind the benefits offered by other companies that you have worked for):
Medical	Choose an item.
Dental	Choose an item.
Vision	Choose an item.
Paid time off	Choose an item.
401(k) plan	Choose an item.
Please list any additional benefits that you would have wanted the company to offer [Click here to enter text.]

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