HUMAN RESOURCE MANAGEMENT AND

DEVELOPMENT SERVICE
GENERAL ADMINISTRATION AND SUPPORT SERVICES GROUP

EXIT INTERVIEW FORM

INTRODUCTION:
Please help us make the DSWD a better place to work at by completing the following
questionnaire. Your honest and open responses are sincerely appreciated and shall
be confidentially reviewed by an HRMDS technical staff. The HRMDS will contact you
for an online/face-to-face interview if warranted. The data obtained will be used in
identifying trends, recognizing areas exceeding expectations, and areas that need
improvement. It will serve to enable us in developing policies and practices that reflect
the needs of our current and future personnel. Rest assured that your responses will
not affect your future references or prospects for re-entry into the Department.
___________________________________________________________________

NAME: ____________________________________________________________
POSITION: _________________________________________________________
DATE HIRED: _______________________________________________________
SEPARATION DATE: _________________________________________________
OFFICE (FO/CO):____________________________________________________
OFFICE/BUREAU/SERVICE/UNIT: ______________________________________
EMPLOYMENT STATUS:______________________________________________
NATURE OF SEPARATION:____________________________________________
___________________________________________________________________
DIRECTIONS: Kindly answer this form and return it directly to the HRMDS-Human
Resource Planning and Performance Management Division.

I. Rate your satisfaction and experience with the following aspects of the
job you are vacating by checking the box of your answer.

1 2 3 4 5
A. Management Extremely Below Average Above Excellent
Poor Average Average

Concern with quality and

excellence
Communication between
management and employees

New employee orientation

Recruitment process

Interest and investment in

employees

Kept employees informed

PAGE 1 of 8

DSWD Central Office, IBP Road, Batasan Pambansa Complex, Constitution Hills, Quezon City, Philippines 1126
Website: http://www.dswd.gov.ph Tel Nos.: (632) 8 931-8101 to 07 Telefax: (632) 8 931-8191
 HUMAN RESOURCE MANAGEMENT AND
DEVELOPMENT SERVICE
GENERAL ADMINISTRATION AND SUPPORT SERVICES GROUP

Did dissatisfaction with the

management influence your
decision to leave? If yes, kindly
explain further on the space
provided.

1 2 3 4 5
B. Salary & Benefits Extremely Below Average Above Excellent
Poor Average Average

Competitive compensation
package

Payroll release schedule

Bonuses/premiums

Cost of living in area

Accessible ATMs

Did dissatisfaction with the

salary & benefits influence your
decision to leave? If yes, kindly
explain further on the space
provided.

1 2 3 4 5
C. Job Functions Extremely Below Average Above Excellent
Poor Average Average

Type of work performed

Fairness & weight of workload

Variety of tasks performed

Adding new responsibilities

Job functions met expectations

PAGE 2 of 8

DSWD Central Office, IBP Road, Batasan Pambansa Complex, Constitution Hills, Quezon City, Philippines 1126
Website: http://www.dswd.gov.ph Tel Nos.: (632) 8 931-8101 to 07 Telefax: (632) 8 931-8191
 HUMAN RESOURCE MANAGEMENT AND
DEVELOPMENT SERVICE
GENERAL ADMINISTRATION AND SUPPORT SERVICES GROUP

Did dissatisfaction with the job

functions influence your decision
to leave? If yes, kindly explain
further on the space provided.

D. Working Conditions & 1 2 3 4 5

Extremely Below Average Above Excellent
Equipment Poor Average Average

Working conditions (lighting,

cubicle position, volume of
employees in the office, etc.)
Tools and equipment provided
(table, chair, computer,
stationery, etc.)
Distance between work and
home

Location of work

Available emergency exits and

equipment
Did dissatisfaction with the
working conditions & equipment
influence your decision to leave?
If yes, kindly explain further on
the space provided.

1 2 3 4 5
E. Growth & Development Extremely Below Average Above Excellent
Poor Average Average

Trainings received

Training opportunities in the

organization
Career development
opportunities

Performance evaluation

Level of input in decisions that

affected you

PAGE 3 of 8

DSWD Central Office, IBP Road, Batasan Pambansa Complex, Constitution Hills, Quezon City, Philippines 1126
Website: http://www.dswd.gov.ph Tel Nos.: (632) 8 931-8101 to 07 Telefax: (632) 8 931-8191
 HUMAN RESOURCE MANAGEMENT AND
DEVELOPMENT SERVICE
GENERAL ADMINISTRATION AND SUPPORT SERVICES GROUP

Did dissatisfaction with growth &

development influence your
decision to leave? If yes, kindly
explain further on the space
provided.

F. Supervisor-Subordinate 1 2 3 4 5
Extremely Below Average Above Excellent
Relationship Poor Average Average

Listened to suggestions and

feedback

Gave performance feedback

Clearly communicated expectations

Provided appropriate and

challenging assignments

Treated you fairly and respectfully

Coached, trained, and developed

you
Encouraged teamwork and
cooperation
Did dissatisfaction with the
supervisor-subordinate relationship
influence your decision to leave? If
yes, kindly explain further on the
space provided.

1 2 3 4 5
G. Organizational Culture Extremely Below Average Above Excellent
Poor Average Average

Commitment to public service

Maintained harmonious
relationship with coworkers

Boosted employee morale

PAGE 4 of 8

DSWD Central Office, IBP Road, Batasan Pambansa Complex, Constitution Hills, Quezon City, Philippines 1126
Website: http://www.dswd.gov.ph Tel Nos.: (632) 8 931-8101 to 07 Telefax: (632) 8 931-8191
 HUMAN RESOURCE MANAGEMENT AND
DEVELOPMENT SERVICE
GENERAL ADMINISTRATION AND SUPPORT SERVICES GROUP

Activities after office hours

Recreational outings

Did dissatisfaction with the

organizational culture influence
your decision to leave? If yes,
kindly explain further on the
space provided.

1 2 3 4 5
H. Work-Life Balance Extremely Below Average Above Excellent
Poor Average Average

Respected personal time outside

working hours

Flexible work arrangement

Competitive leave credits

Provided social support

Promoted health and wellness

Did dissatisfaction with the work-

life balance influence your
decision to leave? If yes, kindly
explain further on the space
provided.

1 2 3 4 5
I. Recognition Extremely Below Average Above Excellent
Poor Average Average

Received recognition for

accomplishments
Linked company goals to
recognition

Offered challenging projects

PAGE 5 of 8

DSWD Central Office, IBP Road, Batasan Pambansa Complex, Constitution Hills, Quezon City, Philippines 1126
Website: http://www.dswd.gov.ph Tel Nos.: (632) 8 931-8101 to 07 Telefax: (632) 8 931-8191
 HUMAN RESOURCE MANAGEMENT AND
DEVELOPMENT SERVICE
GENERAL ADMINISTRATION AND SUPPORT SERVICES GROUP

Encouraged peer-to-peer
recognition

Commendations in IPCR

Did dissatisfaction with

recognition influence your
decision to leave? If yes, kindly
explain further on the space
provided.

II. Kindly answer the following questions candidly.

1. Cite your top ☐ Management

three (3) reasons for ☐ Salary & Benefits
leaving the ☐ Job Functions
Department. ☐ Working Conditions & Equipment
☐ Growth & Development
☐ Supervisor-Subordinate Relationship
☐ Organizational Culture
☐ Work-Life Balance
☐ Recognition
☐ Others: ___________________________________________
2. Cite the positive ☐ Management
aspects in the ☐ Salary & Benefits
Department that ☐ Job Functions
caused you to stay ☐ Working Conditions & Equipment
as long as you did. ☐ Growth & Development
☐ Supervisor-Subordinate Relationship
☐ Organizational Culture
☐ Work-Life Balance
☐ Recognition
☐ Others: ___________________________________________
3. Before making
your decision to
leave, did you
investigate other
options that would
enable you to stay?
If yes, kindly explain
further on the space
provided.

PAGE 6 of 8

DSWD Central Office, IBP Road, Batasan Pambansa Complex, Constitution Hills, Quezon City, Philippines 1126
Website: http://www.dswd.gov.ph Tel Nos.: (632) 8 931-8101 to 07 Telefax: (632) 8 931-8191
 HUMAN RESOURCE MANAGEMENT AND
DEVELOPMENT SERVICE
GENERAL ADMINISTRATION AND SUPPORT SERVICES GROUP

4. What do you
consider to be the
biggest challenge
this organization
now faces and
needs to overcome?

5. In your opinion,
what were the top
three barriers to
productivity in your
job or work unit?

6. What advice
would you give to
the person who will
be appointed to your
vacated position?

7. If given the
chance, will you
apply again to any
vacant position in
the Department?
Why or why not?

8. Do you have any

other comments or
suggestions?

PAGE 7 of 8

DSWD Central Office, IBP Road, Batasan Pambansa Complex, Constitution Hills, Quezon City, Philippines 1126
Website: http://www.dswd.gov.ph Tel Nos.: (632) 8 931-8101 to 07 Telefax: (632) 8 931-8191
 HUMAN RESOURCE MANAGEMENT AND
DEVELOPMENT SERVICE
GENERAL ADMINISTRATION AND SUPPORT SERVICES GROUP

9. On a scale of 1-
10, how likely are
you to recommend
the Department to
others as a place to
work? Kindly explain
further on the space
provided.

III. If you have accepted a position in another organization, please complete

the following:

Name of New Employer

Location of Position

Position Title

Nature of Work

Salary Offered

What does your new

position and/or
organization offer that the
Department does not?

Thank you!

PAGE 8 of 8

DSWD Central Office, IBP Road, Batasan Pambansa Complex, Constitution Hills, Quezon City, Philippines 1126
Website: http://www.dswd.gov.ph Tel Nos.: (632) 8 931-8101 to 07 Telefax: (632) 8 931-8191