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Mvsu Employee Exit Interview Form Revised 3-16-22 0

The employee exit interview form collects information about an employee's departure including their job title, length of employment, reasons for leaving, contact information, and ratings of their manager, department, benefits, and working conditions. The form is used to maintain confidentiality and ensure a smooth transition by collecting keys, ID badges, and other returnable items from the departing employee.

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sukisno fajriansah

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0% found this document useful (0 votes)

31 views3 pages

Mvsu Employee Exit Interview Form Revised 3-16-22 0

Uploaded by

sukisno fajriansah

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

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Employee Exit Interview Form

Employee Name ______________________________________________________________

Date of Interview: ______________________________________________________________

Last Day of Employment: __ DEPARTMENT:

I would appreciate it if you would take a few minutes to respond to the questions below.
All answers will be held in strict confidence. Thank you.

How long were you employed? _ Job Title?

Why are you leaving? __________________________________________________________

____________________________________________________________________________

If moving, need forwarding address for tax documentation, cobra, etc. ____________________

____________________________________________________________________________

Would you describe your working relationship (with respect to both your particular job and your
relationship with fellow workers) as pleasant or unpleasant? What did you like least about
working here? What did you like about working here?

____________________________________________________________________________

Do you feel that your particular job was important and significant in the overall operation of the
business? Do you feel you were treated fairly while at the University?

____________________________________________________________________________

How did you feel about your chances for advancement? _______________________________

____________________________________________________________________________

Is there any problem that you know about (or heard) concerning the University? ____________

____________________________________________________________________________
Are there any particular or working conditions that either led to your decision to resign or that
you feel are detrimental to a satisfactory working relationship? If so, have you any suggestions
on how to eliminate them?

____________________________________________________________________________

Are there any particular practices or working conditions that you feel are particularly beneficial to
an effective working relationship and that should be maintained? What changes would have to
take place for you to come back?

____________________________________________________________________________

Rate your Manager on the following:

Always Usually Sometimes Never

Follow policies &
procedures
Treats employees in a fair
and equal way
Provides recognition for a
job well done
Resolves complaints and
problems
Gives needed information
Keeps employees busy
Knows his/her job well
Welcomes suggestions
Maintains discipline

What do you think of the following in your department?

Excellent Good Fair Poor

Cooperation/teamwork in the
department
Cooperation with other
departments
Department training and OTJ
training
Communications
Working Conditions
Work Schedule
How do you feel about the following?

Excellent Good Fair Poor

Rate of Pay for your job
Amount of paid leave accrual
Health Insurance program
Tuition Assistance program
Retirement Plan

Clearance Information (To be completed by HR)

COBRA Information (will be supplied by different vendors) Written Resignation

Keys Other

ID Badge

Personnel Release form turned in

ACKNOWLEDGEMENT OF CORPORATE COMPLIANCE RESPONSIBILITIES

I have no knowledge of any violation of the law or any corporate policies or standards
of conduct by me or any other employees while I have been employed at the University.
If I recall any suspected violations in the future, I will immediately report them to the
Compliance Officer.

Would you care to make any other comments?

_____________________________________________________________________ _
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Signed: ____________ Date: _

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Mvsu Employee Exit Interview Form Revised 3-16-22 0

Uploaded by

Mvsu Employee Exit Interview Form Revised 3-16-22 0

Uploaded by

Employee Exit Interview Form

Employee Name ______________________________________________________________

Date of Interview: ______________________________________________________________

Last Day of Employment: ______________________ DEPARTMENT: ____________________

How long were you employed? _____________________ Job Title? ____________________

Why are you leaving? __________________________________________________________

Rate your Manager on the following:

Always Usually Sometimes Never

What do you think of the following in your department?

Excellent Good Fair Poor

Excellent Good Fair Poor

Clearance Information (To be completed by HR)

COBRA Information (will be supplied by different vendors) Written Resignation

Personnel Release form turned in

ACKNOWLEDGEMENT OF CORPORATE COMPLIANCE RESPONSIBILITIES

Would you care to make any other comments?

Signed: ________________________________ Date: _____________________

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Last Day of Employment: __ DEPARTMENT:

How long were you employed? _ Job Title?

Signed: ____________ Date: _