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Employee Exit Interview Form

This document is an exit interview form for an employee leaving their position at the Department of Health (DOH). It collects information about the employee's reasons for leaving, what initially attracted them to DOH, and their satisfaction with various aspects of their employment experience. The form asks the employee to specify their main reason for leaving such as health concerns, accepting other employment, or relocating. It then has them rate their level of agreement with statements about their working relationships, training, workload, understanding of duties, working conditions, pay, benefits, schedule, supervision, and advancement opportunities. Space is provided for additional comments.

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OR-DR AREA
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218 views

Employee Exit Interview Form

This document is an exit interview form for an employee leaving their position at the Department of Health (DOH). It collects information about the employee's reasons for leaving, what initially attracted them to DOH, and their satisfaction with various aspects of their employment experience. The form asks the employee to specify their main reason for leaving such as health concerns, accepting other employment, or relocating. It then has them rate their level of agreement with statements about their working relationships, training, workload, understanding of duties, working conditions, pay, benefits, schedule, supervision, and advancement opportunities. Space is provided for additional comments.

Uploaded by

OR-DR AREA
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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MeDOH-RO VII

Human Resource Management Office

EMPLOYEE EXIT INTERVIEW FORM

LAST NAME / FIRST NAME / MIDDLE INITIAL

POSITIONEFFECTIVE DATE OF RESIGNATION

DIVISION SECTION

1. What was your main reason for leaving DOH?

Health Concerns Accept Other Employment To Continue Education

Relocation Family Needs/Responsibilities Manage Own/Family Business

Others (Please state)


_______________________________________________________________________________________________
___________________________________________________________________

a. If one of your reasons for leaving is “Relocation”, please specify the reason.

Going Abroad to (Country)

To relocate with spouse / family

Others (Please state)


_______________________________________________________________________________________________
_________________________________________________________________

b. If your reason for leaving is “To Accept Other Employment”, please specify the reason(s).
Please check all applicable.

Promotion/Career Advancement Distance To/From Work

Work Schedule Better Benefits Better Pay Career Change

Others (Please state)


_______________________________________________________________________________________________
_________________________________________________________________

2. What attracted you to work for DOH?

3. What did you like most about your employment experience at DOH?
1
__________________________________________________________________________________

4. What did you like least about your employment experience at DOH?

Please mark your choice with a check mark:

Strongly Agree Disagree Strongly


Agree Disagree

 I had a good working relationship with 4 3 2 1


co-employees

 I had a good working relationship with my 4 3 2 1


supervisor

 Training or job development met 4 3 2 1


expectations.

 Work load/demands were manageable. 4 3 2 1

 I had a clear understanding of my job duties. 4 3 2 1

 Working conditions met expectations. 4 3 2 1

 Pay was fair for the amount of work required. 4 3 2 1

 The benefits were competitive. 4 3 2 1

 My work schedule met my needs. 4 3 2 1

 My supervisor’s management style is 4 3 2 1


effective.

 Advancement opportunities are easy to 4 3 2 1


achieve.

 Overall, I was satisfied with my job. 4 3 2 1

Use the space provided below for additional comments you may have on any of the areas you have just rated.

_______________________ _______________
Employee’s Signature Date

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