First Name
Last Name
Employee ID:
Department:
Job Title:
Start Date:
Last Date of Employment:
Reason for Leaving:
New Employer:
New Job Title:
Would you be willing to participate in an exit interview?
Click "Yes" to see the exit interview questions.
What were the primary reasons for your decision to leave?
What did you enjoy most about your time at the company?
What did you enjoy least about your time at the company?
What suggestions do you have for improving the work environment?
Please rate.
Your Opinions For The Following Questions | 1: Poor, 2: Fair, 3: Good, 4: Excellent | ||
|---|---|---|---|
A | B | ||
1 | How would you rate the work-life balance of your employment? | ||
2 | How would you rate the management support of your employment? | ||
3 | How would you rate the opportunities for growth of your employment? | ||
4 | How would you rate the compensation and benefits of your employment? | ||
5 | How would you rate the teamwork and collaboration of your employment? | ||
6 | How would you rate the company culture of your employment? |
Do you feel you were given adequate training and resources to perform your job effectively, and why?
Do you have any concerns regarding workplace harassment or discrimination, and what are they?
Would you recommend this company to a friend or colleague?
Any other comments or feedback?
Have you returned all company-owned assets?
Returned Items:
Item | Serial Number/Identifier | ||
|---|---|---|---|
A | B | ||
1 | |||
2 | |||
3 | |||
4 | |||
5 | |||
6 | |||
7 | |||
8 | |||
9 | |||
10 |
Items That Still Need To Be Returned:
Item | Serial Number/Identifier | Planned Returned Date | ||
|---|---|---|---|---|
A | B | C | ||
1 | ||||
2 | ||||
3 | ||||
4 | ||||
5 | ||||
6 | ||||
7 | ||||
8 | ||||
9 | ||||
10 |
Please answer the following questions.
Checklist Item | Tick if Yes | ||
|---|---|---|---|
A | B | ||
1 | Have you returned all company documents and files? | ||
2 | Have you transferred all pending tasks and projects to your manager or designated colleagues? | ||
3 | Have you returned your company payment card (Visa, Mastercard, etc.)? | ||
4 | Have you deleted all company information from personal devices? | ||
5 | Have you changed all account credentials relating to company accounts? | ||
6 | Have you forwarded any important contact information to the appropriate person? | ||
7 | Do you understand the company's confidentiality and non-disclosure policies? | ||
8 | Do you understand the company's policy regarding post-employment restrictions? | ||
9 | Have you completed all necessary expense reports? | ||
10 | Have you updated your personal contact information for final pay and W-2/T4 purposes? | ||
11 | IV. IT/System Access | ||
12 | Has your network access been revoked? | ||
13 | Has your email account been deactivated? | ||
14 | Have all software licenses been returned? | ||
15 | Have all cloud based account accesses been removed? | ||
16 | V. HR/Benefits | ||
17 | Have you received information regarding your final pay and benefits? | ||
18 | Do you understand your COBRA/continuation of benefits options? | ||
19 | Have you received information regarding your 401(k)/retirement plan? | ||
20 | Have you confirmed your final address for receiving any final documents? | ||
21 | Do you have any remaining questions regarding your benefits? |
Form Template Instructions
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Strengths:
Comprehensive Coverage:
Clear Structure:
Feedback Focus:
Asset Accountability:
Potential Areas for Improvement and Insights:
IT/System Access Verification:
HR/Benefits Clarity:
Confidentiality Reminder:
Post-Employment Contact:
Legal Review:
General Insights:
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