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Exit Interview

Name (optional)

Supervisor (optional)

Department

Position

Why are you leaving the company?

Personal Reasons
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Please explain your reasons for leaving in more detail.

What suggestions for improvement do you have for us?

If we implement those suggestions, would you return to work here?

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Business Demographic Survey

What best describes your employment status?

Employed full time
Single, never married
Trade or Vocational degree
Not employed, but looking for work
Not employed and not looking for work
Retired
Student
Homemaker
Prefer not to answer

What best describes your level of education?

Some high school
High school graduate or equivalent
Trade or Vocational degree
Some college
Associate degree
Bachelor's degree
Graduate or professional degree
Prefer not to answer

In which industry do you work?

Which of the following most accurately describes your primary functional work area?

Account Management
Administrative
Administering Health Services
Advertising
Business Development
Clerical / Processing
Creative / Design
Consulting
Customer Service / Support
Distribution
Education
Engineering
Executive Management
Finance
Human Resources
Information Technology / Information Systems
Legal
Merchandising
Operations / Production
Purchasing
Research & Development
Sales
Other
Don't Work

CEO / President / Owner / General Manager / Partner
Vice President / Assistant Vice President
CFO / Treasurer / Controller
Director / Assistant Director / Department Head
Manager / Assistant Manager
Professional (salaried)
Technical (hourly)
Small Business Owner
Clerical / Administrative Support
Doctor / Physician
Developer / Programmer
Lawer
Sales Representative
Customer Service
Supervisor
Educator
Staff
Other
Don't Work

How long have you worked for your company

Less than 3 months
Between 3 to 6 months
Between 6 monts to 1 year
Between 1 to 3 years
Between 3 to 5 years
Between 5 to 10 years
More than 10 years
Don't work

How many total employees are in your company?

Under 10
10 to 20
20 to 50
50 to 100
100 to 150
150 to 500
500 to 1000
1000 to 5,000
5000 to 10,000
10,000 to 15,000
15,000 to 25,000
25,000 or more
Don't work

What are the annual revenues of your company / organization?

Under $10,000
$10,000 to $50,000
$50,000 to $100,000
$100,000 to $500,000
$500,000 to $1 Million
$1 Million to $10 Million
$10 Million to $50 Million
$50 Million to $100 Million
$100 Million to $1 Billion
Over $1 Billion
Don't know
Don't work
Prefer not to answer

Customer Satisfaction Survey

Please take a few moments to complete this satisfaction survey.

How long have you used our product / service?

Less than a month
1-6 months
1-3 years
Over 3 Years
Never used

How often do you use product / service?

Once a week
2 to 3 times a month
Once a month
Less than once a month

Overall, how satisfied were you with the product / service?

Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
N/A

What aspect of the product / service were you most satisfied by?

Quality
Price
Purchase Experience
Installation or First Use Experience
Usage Experience
Customer Service
Repeat Purchase Experience

What aspect of the product / service were you most disappointed by?

Quality
Price
Purchase Experience
Installation or First Use Experience
Usage Experience
Customer Service
Repeat Purchase Experience

What do you like about the product / service?

What do you dislike about the product / service?

Thinking of similar products / services offered by other companies, how would you compare the product / service offered by our company?

Much Better
Somewhat Better
About the Same
Somewhat Worse
Much Worse
Don't Know

Would you use our product / service in the future?

Definitely
Probably
Not Sure
Probably Not
Definitely Not

Would you recommend our product / service to colleagues or contacts within your industry?

Definitely
Probably
Not Sure
Probably Not
Definitely Not