Use the Exit Interview Form Template

Name *

First

Last

Job title *

Manager's name *

First

Last

Would you like to receive a follow-up email?

Personal email address *

Email

Confirm Email

Why are you leaving your job with ACME Corp?

Please share some information about your decision to leave ACME Corp

What prompted you to seek another job?

What specifically makes the new job more attractive to you?

Please tell us why your new job is more attractive to you

What prompted you to return to freelance work?

What specifically makes freelance work more attractive to you?

Please tell us why freelance work is more attractive to you

Did you have any specific issues or complaints that made you want to leave your job? *

Did you raise those issues with a senior team member?

Please think about conversations with senior employees, supervisors, managers, and HR.

Please describe what happened when you raised the issue(s)

Was the issue resolved?

Please rate your satisfaction with your job at ACME Corp

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I enjoyed my job	Strongly DisagreeI enjoyed my job Strongly Disagree	DisagreeI enjoyed my job Disagree	NeutralI enjoyed my job Neutral	AgreeI enjoyed my job Agree	Strongly AgreeI enjoyed my job Strongly Agree
The job matched the job description	Strongly DisagreeThe job matched the job description Strongly Disagree	DisagreeThe job matched the job description Disagree	NeutralThe job matched the job description Neutral	AgreeThe job matched the job description Agree	Strongly AgreeThe job matched the job description Strongly Agree
My salary was appropriate	Strongly DisagreeMy salary was appropriate Strongly Disagree	DisagreeMy salary was appropriate Disagree	NeutralMy salary was appropriate Neutral	AgreeMy salary was appropriate Agree	Strongly AgreeMy salary was appropriate Strongly Agree
I had a good relationship with my manager	Strongly DisagreeI had a good relationship with my manager Strongly Disagree	DisagreeI had a good relationship with my manager Disagree	NeutralI had a good relationship with my manager Neutral	AgreeI had a good relationship with my manager Agree	Strongly AgreeI had a good relationship with my manager Strongly Agree
I enjoyed the team culture	Strongly DisagreeI enjoyed the team culture Strongly Disagree	DisagreeI enjoyed the team culture Disagree	NeutralI enjoyed the team culture Neutral	AgreeI enjoyed the team culture Agree	Strongly AgreeI enjoyed the team culture Strongly Agree

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