Fillable EXIT INTERVIEW FORM Are you planning to move? (Servant HR)

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EXIT INTERVIEW FORM Are you planning to move? (Servant HR)

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Exit Interview Form- Servant HR 08/2016
EXIT INTERVIEW FORM
Department:
Yes No
Yes No
Yes No
Yes No
Date:
Name:
Are you participating in our employer sponsored insurance plan?
Are you participating in our employer sponsored retirement plan?
Are you in possession of any company property?
(keys, pager, information, etc.)
Please list:
What is the reason for your leaving?
Were you satisfied in the following areas:
1. Your Job: (fit w/ interests, abilities, opportunities, work load, training, etc.)
2. Supervi
sion & Management: (Fairness, working environment, etc.)
3. Company Policies & Practices: (fairness, working environment,
etc.)
Original Hire Date:
New Address:
Last Day Worked:
Are you planning to move?
Exit Interview Form- Servant HR 08/2016
4. Salary & Employee Benefits: (fairness, awareness, within industry standards, etc.)
Wh
at did you like most about working at the company?
Wh
at did you like least about working at the company?
Wh
at do you feel needs to be improved at the company?
We
re you treated fairly while with the company ? If not, what was your complaint?
My
reason(s) for leaving the company has nothing to do with a work-related problem or grievance.
Agree Disagree
Is there any problem that you know about or you have heard others talk about concerning the
company?
Mus
t something change for you to come back? If yes, what?
No Would you return to work at the company in the future if the opportunity were available? Yes
If no, why?
Now that we have heard about your experience with your previous employer, we’d like you to
briefly share about your experience with Servant HR. As a company, we can always grow and
your thoughts help us do that.
Exit Interview Form- Servant HR 08/2016
1. Were you satisfied with your experience with Servant HR as your co-employer and HR
representatives?
2. Describe your interactions with Servant HR. (Asking questions, presenting requests, submitting
grievances or complaints, customer service, over the phone, email communication, overall
service, etc.)
3. What do you feel needs to be improved at Servant HR?
For Office Use:
Explain final pay policy and give (or arrange for) final checks to employee:
Remind employee to keep company informed about address change for tax purposes:
Other comments/interviewer’s assessment:
Interviewer Date
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EXIT INTERVIEW FORM Are you planning to move (Servant HR)

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Completed 16 December 2020

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