BNCC FORMS

Employee Name

Employee Title

Employee Number

Department

Manager Name

Manager Title

Date of Hire

Date of Termination

This is an exit interview. This form will be used as a reference to find out how we can improve the satisfaction of our employees in the future. Please rate your experience in the company using the following scale:

1 –Very Satisfied
2 –Satisfied
3 –Average
4- Dissatisfied
5 –Very Dissatisfied

Salary	1	2	3	4	5
Benefits	1	2	3	4	5
Company management	1	2	3	4	5
Nature of the job	1	2	3	4	5
Communication	1	2	3	4	5
Company policy	1	2	3	4	5
Workload	1	2	3	4	5
Training & Education	1	2	3	4	5
Opportunity for Advancement	1	2	3	4	5
Overall of the job	1	2	3	4	5

Totals Points / Number of Factors Rate =

1. Why are you leaving?

2. If you are going to another job, what does that job offer that your job here did not?

3. What factors contributed to your accepting a job here? Were your expectations realized?

4. How would you evaluate your salary in comparison to the work that you performed?

5. What are some of the factors that helped to make your employment here enjoyable?

6. What comments or suggestions do you have in regard to making this a better place to work?

7. Would you recommend our organization to a friend as a place to work? If yes, why? If no, why not?

Interviewer’s signature

Date

Employee’s signature

Date