Exit Interview Form Template

Name, Department, If selected other, please specify:, Supervisor's Name, Exit Interview Conducted by

Date of Separation & Date

Reason for Leaving

How satisfied were you with your overall job experience?, How would you rate your supervisor's performance?, How would you rate your relationships with your coworkers, How would you rate the company culture?, How satisfied were you with your compensation and benefits package?

Please provide the main reasons for your decision to leave the company/firm., What could be improved about your supervisor's performance?, What could be improved about your relationships with your coworkers?, What could be improved about the company culture?, What could be improved about your compensation and benefits package?, What are your career goals and aspirations?, Please use this part to add any additional feedback or comments

Signature