CONFIDENTIAL
EMPLOYEE EXIT INTERVIEW

PURPOSE:
The intent of this Exit Interview is to ensure that any exiting employee is informed of his/her rights and benefits and that accurate records regarding termination of employment are collected and maintained.

POLICY:
It is the policy of ${input_44_3} to ensure that any employee whose employment is being terminated, whether voluntarily or involuntarily, receives an exit interview. The exit interview shall be conducted by ${input_44_5} . The objectives of the exit interview are as follows:

-       To determine and discuss the employee's reason for resignation, if applicable;

-       To discover and discuss any grievances that the employee may have regarding the department or position held in an effort to institute any corrective action(s), if any; which may be deemed necessary

-      To discover and discuss any misunderstandings the employee may have had about his/her job or with his/her supervisor(s) in an effort to institute any corrective action(s), if any, which may be deemed necessary;

-      To maintain good will and teamwork amongst current and future employees;

-      To review administrative details with the employee such as benefit continuation rights and conversion privileges, if any, final pay, re-employment policy, and employment compensation; and

-      To arrange for the return of any company property which may be in the possession of the leaving employee and has not already been returned to the department supervisor.

PROCEDURE:
Upon an employee's announcement of his/her intent to resign, the supervisor/department head shall schedule an exit interview for the employee with ${input_44_5} or his/her designee as soon as possible.

In the event that a decision has been made to terminate an employee, the employee shall meet with ${input_44_5} or his/her designee for an exit interview as soon as possible, or as deemed appropriate.

Throughout the duration of the exit interview, ${input_44_5} , or his/her designee, shall seek to meet all objectives listed within the Exit Interview Policy.

The departing employee shall complete the following Exit Interview Form as thoroughly as possible.

Any information obtained during the exit interview may be disclosed to and/or discussed with the employee's supervisor, the Department Head or other management heads, as deemed necessary, in order to investigate any allegation(s) made or to inform them of any emerging problem(s).

EMPLOYEE NAME:	${input_44_8}
JOB TITLE:	${input_44_11}
DIVISION/UNIT:	${input_44_12}
START DATE:	${input_44_17}
SEPARATION DATE:	${input_44_18}
TOTAL LENGTH OF SERVICE:	${input_44_19}
REASON FOR LEAVING:	${input_44_22}

REASONS FOR LEAVING:

Have you spoken with anyone, either your Supervisor or a Human Resource Representative, about your career goals?

___Yes

___No

If yes, what was the outcome of this conversation?

If no, why have you not spoken with anyone regarding your career goals?

In your opinion, have there been adequate career opportunities available within ${input_44_3} ?

___Yes

___No

What types of career opportunities are important to you? (Select all that apply)

__Promotional Opportunities	__Special Projects	__Increased Responsibilities
__Position Rotations	__Overseas	__Not looking for any Progression

__Other_________________________________________________________________

COMPENSATION
How satisfied were you with the compensation offered?(Select One)

__Dissatisfied

__Reasonably Satisfied

__Satisfied

What other benefits do you wish you had received as an employee of the company?

MANAGEMENT

Were you able to openly communicate and get along with your Supervisor?

___Yes

___No

If no, please explain:

Was your Supervisor able to handle and resolve any complaints or grievances you may have had?

___Yes

___No

If no, please explain:

What could have been done to make your job here more satisfying and rewarding?

How would you describe the management style within your department? (Select all that apply)

__Inspirational/Motivating	__Flexible	__Progressive/Innovative
__Approachable/Supportive	__Consultative	__Competent
__Bureaucratic	__Directive	__Inflexible
__Uninterested	__Other	_______________________________

If you could build upon your Supervisor's effectiveness, what recommendations would you make?

FEEDBACK
How often did you receive feedback from your Supervisor/Manager? (Select all that apply)

__Regular Written Feedback	__Regular Oral Feedback
__Occasional/Arranged Feedback	__Never Received Feedback

If feedback was provided, select the type of feedback given during your employment.(Select all that apply)

__Performance Appraisals	__Informal Feedback
__Verbal Feedback	__None

How would you describe the quality of feedback you received?

JOB SATISFACTION
Please rate your satisfaction for each of the following:

Job Responsibilities

__Outstanding

__Very Good

__Satisfactory

__Fair

__Unsatisfactory

Opportunity for Achieving Goals

__Outstanding

__Very Good

__Satisfactory

__Fair

__Unsatisfactory

Work Environment

__Outstanding

__Very Good

__Satisfactory

__Fair

__Unsatisfactory

Supervisor

__Outstanding

__Very Good

__Satisfactory

__Fair

__Unsatisfactory

Job Responsibilities

__Outstanding

__Very Good

__Satisfactory

__Fair

__Unsatisfactory

Pay

__Outstanding

__Very Good

__Satisfactory

__Fair

__Unsatisfactory

Benefits

__Outstanding

__Very Good

__Satisfactory

__Fair

__Unsatisfactory

What did you enjoy most about your job?

What did you enjoy least about your job?

What makes ${input_44_3} a good place to work?

What makes ${input_44_3} a good place to work?

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What recommendations would you have for making your department and ${input_44_3} as a whole a better place to work?

Would you have stayed if a more satisfactory arrangement could have been worked out?

___Yes

___No

If yes, please explain:

Were you informed that the completion of the Exit Interview form was voluntary and were you given the option to not complete the form if you so desired?

___Yes

___No

Please sign and date this form below authorizing the placement of this Exit Interview form within your personnel file.

Employee Signature:______________________________

Dated:_________