Exit Interview Questionnaire Form

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Coastal Connections, Inc.
Exit Interview Questionnaire
Employee Name
Hire Date
Department
Termination Date
Position
Please briefly describe the circumstances for your separation from Company Name:
How would you rate the following aspects of your job?
Needs
Adequate
Inadequate
Improvement
Supervision Received
Development Opportunities
Working Conditions
Workload
Pay
Benefits
Other
Would you please specify:
If you are going to a new employer, what does the new job offer that your job with us did not?
Additional comments about your job, department, or our company.

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