Exit Interview
Answers marked with a * are required.
Page 1
1.
Employee:
First name
Last name
Department
2.
Supervisor:
First name
Last name
3.
Why are you leaving the company?
Going back to School
Better Opportunity
Personal Reasons
Medical Benefits
Salary
Work Environment
Other (Please Specify)
4.
Please explain your reasons for leaving in more detail.
5.
Would you recommend this company to your friends and family as a good place to work?
Yes
No