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	I enjoyed my job Strongly Disagree	I enjoyed my job Disagree	I enjoyed my job Neutral	I enjoyed my job Agree	I enjoyed my job Strongly Agree
The job matched the job description	The job matched the job description Strongly Disagree	The job matched the job description Disagree	The job matched the job description Neutral	The job matched the job description Agree	The job matched the job description Strongly Agree
My salary was appropriate	My salary was appropriate Strongly Disagree	My salary was appropriate Disagree	My salary was appropriate Neutral	My salary was appropriate Agree	My salary was appropriate Strongly Agree
I had a good relationship with my manager	I had a good relationship with my manager Strongly Disagree	I had a good relationship with my manager Disagree	I had a good relationship with my manager Neutral	I had a good relationship with my manager Agree	I had a good relationship with my manager Strongly Agree
I enjoyed the team culture	I enjoyed the team culture Strongly Disagree	I enjoyed the team culture Disagree	I enjoyed the team culture Neutral	I enjoyed the team culture Agree	I enjoyed the team culture Strongly Agree

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