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Sample Exit Interview Form

This exit interview form collects information about an employee leaving their job, including their name, employee number, department, supervisor, last date of employment, date notice was given, whether they would be recommended for rehire and why, the reason for their departure such as dismissal, retirement, layoff, or resignation, any notes, the interviewee's name and signature, and date of the interview. The form is used to document an exit interview conducted with an employee upon their departure from their role at a company.

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Fred Nazareno Cerezo
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474 views1 page

Sample Exit Interview Form

This exit interview form collects information about an employee leaving their job, including their name, employee number, department, supervisor, last date of employment, date notice was given, whether they would be recommended for rehire and why, the reason for their departure such as dismissal, retirement, layoff, or resignation, any notes, the interviewee's name and signature, and date of the interview. The form is used to document an exit interview conducted with an employee upon their departure from their role at a company.

Uploaded by

Fred Nazareno Cerezo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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SAMPLE EXIT INTERVIEW FORM

Employee’s Name ________________________Job Title __________________________


Employee Number _______________________ Department _______________________
Last Date of Employment __________________ Employee’s Supervisor ______________

Date Notification was Given ________________

Would you recommend for rehire?  Yes  No

Please Explain:

Reason for Employee’s Departure:

 Dismissal (Documentation attached.)


 Retirement
 Layoff (if temporary, expected date of rehire) ________________
 Resignation
 Others (please provide details)
___________________________________________________________________
___________________________________________________________________
________________________________________________________________

Notes:

Interviewee Name: _____________________________


Signature: ____________________________________
Date of Interview: ______________________________

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