Employee Exit Survey Form

What is your full name?

What department do you work in?

Why are you exiting your role at this organization?

Please select from the dropdown below which description would describe your exit:

Benefits / Vacation Selected

What specific Benefits or Vacation plan did this new employer offer you that you were not receiving from your current employer?

Compensation / Pay Selected

Did you feel you were paid fairly for the job you performed at this company?

Please provide justification for your selection above.

Are you comfortable providing the new rate of pay you will be earning at your new job?

How much will be earning on an hourly basis or annual basis in your new role?

Coworkers Selected

Are you comfortable providing names of the employee or employees who made your experience at this company unfavorable?

Please provide the name(s) of the coworker(s) as well as details as to why you ultimately decided to seek employment elsewhere below:

Career Opportunities Selected

Since you have selected the lack of career opportunities, can you describe exactly what your current employer did not offer from a career opportunity perspective that you will get at your new place of employee?

What would you suggest your current employer do to improve its current career development as well as career progressions for its staff?

Management / Supervisor Selected

What is your manager or direct supervisors name?

Since you selected management or supervision as your reason for leaving, are you comfortable discussing why your manager or supervisor contributed to you leaving your position with your current company?

Can you describe exactly what your manager or supervisor did that contributed to you resigning from this career?

Work Environment Selected

Since you chose work environment as your reasoning for leaving your employment, please describe what caused you to decide to leave?

What suggestions do you have that would help your current employer to improve their work environment?

Other Selected

Since you selected other, this is an open ended answer, please enter in the reasoning which contributed to you resigning from this organization below.

This page was last updated on 4/21/2023 @ 11:53 PM CDT

The employees name is:

The employees Department is:

The employee is exiting this organization due to:

The reason for the employees departure is:

The new employer offered the employee the following benefits / vacation package:

The reason for the employees departure is:

The employee's opinion of their pay at the organization was:

The employees comfort with providing the new pay rate at their new employer is:

The employees new compensation at their new position will be:

The reason for the employees departure is:

The employees comfort level with providing coworkers names who contributed to their decision to terminate employment is:

The following are the details regarding the names and reasons for the employee terminating employment as a result of their coworkers:

The reason for the employees departure is:

The employee states the reason for their departure from a career opportunity perspective is:

The employee has the following suggestions and feedback to improve the current state of career opportunites:

The reason for the employees departure is:

The employees direct supervisor or manager is:

The employees comfort level with providing reasoning why their supervisor or manager contributed to decision to terminate employment is:

The employee states the reason why their manager or supervisor contributed to their decision to leave employment is because:

The reason for the employees departure is:

The employees justification to why they chose the Work Environment as the contributing factor for them leaving employment is:

The employees suggestions to improve the workplace environment are:

The reason for the employees departure is:

The employees justification for choosing the OTHER reason code is:

Workforce 2080 LLC provides this Employee Exit Survey Form for free to help employees and employers collect employee feedback when exiting an organization for the purposes of improving the employer. Workforce 2080 LLC assumes no liability or risk for the information provided by this form; each person or user who utilizes this form understands all decisions made by the individual is solely their own.

Employee Exit Survey Form

Employee Exit Survey Form

Benefits / Vacation Selected

Compensation / Pay Selected

Coworkers Selected

Career Opportunities Selected

Management / Supervisor Selected

Work Environment Selected

Other Selected

Do you love this free Employee Exit Survey Form?

The employees name is:

The employees Department is:

The employee is exiting this organization due to:

The reason for the employees departure is:

The new employer offered the employee the following benefits / vacation package:

The reason for the employees departure is:

The employee's opinion of their pay at the organization was:

The employees comfort with providing the new pay rate at their new employer is:

The employees new compensation at their new position will be:

The reason for the employees departure is:

The employees comfort level with providing coworkers names who contributed to their decision to terminate employment is:

The following are the details regarding the names and reasons for the employee terminating employment as a result of their coworkers:

The reason for the employees departure is:

The employee states the reason for their departure from a career opportunity perspective is:

The employee has the following suggestions and feedback to improve the current state of career opportunites:

The reason for the employees departure is:

The employees direct supervisor or manager is:

The employees comfort level with providing reasoning why their supervisor or manager contributed to decision to terminate employment is:

The employee states the reason why their manager or supervisor contributed to their decision to leave employment is because:

The reason for the employees departure is:

The employees justification to why they chose the Work Environment as the contributing factor for them leaving employment is:

The employees suggestions to improve the workplace environment are:

The reason for the employees departure is:

The employees justification for choosing the OTHER reason code is:

Employee Exit Survey Form

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