CONFIDENTIAL REFERENCE NUMBER:

___________________

EXIT INTERVIEW FORM CONFIDENTIAL

Exit Questionnaire
(To be accomplished by resignee)
We will appreciate your taking the time to answer the following questions as openly and honestly as possible. We believe that the information you will give will
allow us to better understand the Company’s different areas for improvement. We assure you that your individual responses will be treated and kept confidential.

Tenure Functional Area

Name: Less than one year Sales & Marketing Information Technology

Position: 1-2 years BD/BR Medical Services

Department: 2-3 years CDT Finance

Hiring Date: 3-5 years Marketing Actuarial

Separation Date: 5-7 years Operations Human Resources

More than 7 years MSAD

CSAD

Branch Admin

Part I: Your Reasons for Leaving Us

Choose three (3) most important reasons why you decided to leave us (1 is the most important in the order of importance).

Compensation/Salary Relationship with supervisors Further education/training

Benefits Company culture & values Managing work/life balance

Leadership Work environment Personal/family business

Quality of management Job content Health

Issuer : HRD
Effectivity Date : 10/1/2018
Form Number : HRD-FO-031
Version : 2

Page 1 of 4
 Direction business is heading Company/department policies Migration

Relationship with co-workers Career change Others, please specify

__________________________

Part II: Your Views on Working in the Company

Below are a number of statements about different aspects of your work life in the Company. Indicate the degree of your agreement or disagreement
with each of these statements and the impact of these statements to your decision to leave by encircling the appropriate number of your choice.

Your view on this statement Impact on your decision to leave

Strongly Disagree Agree Strongly Don’t High Mediu Low No
Disagree Agree know m Impact
My Total Compensation
 I feel fairly paid for the work I perform for the 1 2 3 4 0 1 2 3 0
company.
 I feel properly rewarded for my contribution to the 1 2 3 4 0 1 2 3 0
business.
 I feel that my compensation package compares well 1 2 3 4 0 1 2 3 0
with other companies.
Leadership and Quality of Management
* Senior Management refers to business heads and
their direct reports
* My Manager refers to your direct boss to whom you
report daily.
 Senior Management provides and communicates 1 2 3 4 0 1 2 3 0
clear direction of the business or functional
objectives and expectations.
 Senior management values individual employee’s 1 2 3 4 0 1 2 3 0
contribution.
 Senior management listens to employees’ views 1 2 3 4 0 1 2 3 0
before making decisions.
 My manager clearly communicates his/her 1 2 3 4 0 1 2 3 0
expectations of me and provides me feedback and
coaching.

Issuer : HRD
Effectivity Date : 10/1/2018
Form Number : HRD-FO-031
Version : 2

Page 2 of 4
 Your view on this statement Impact on your decision to leave
Strongly Disagree Agree Strongly Don’t High Mediu Low No
Disagree Agree know m Impact
 My manager encourages opportunities for growth 1 2 3 4 0 1 2 3 0
by providing increased challenges and
responsibilities.
 My manager is accessible and approachable. 1 2 3 4 0 1 2 3 0
 There is an open communication between me and 1 2 3 4 0 1 2 3 0
my boss.
 My manager gives serious consideration to my 1 2 3 4 0 1 2 3 0
ideas and suggestions.
My Relationship with Others
 I enjoy working with my manager. 1 2 3 4 0 1 2 3 0
 I can relate well with my subordinates/co-workers. 1 2 3 4 0 1 2 3 0
 My customers or clients give me positive feedback 1 2 3 4 0 1 2 3 0
about my work.
 Communication across departments is effective. 1 2 3 4 0 1 2 3 0
Company Culture and Direction
 I am aware of the business directions. 1 2 3 4 0 1 2 3 0
 I share the same values with the Company. 1 2 3 4 0 1 2 3 0
 Managers and employees walk their talk. 1 2 3 4 0 1 2 3 0
 Overall, I believe this is a good place to work in. 1 2 3 4 0 1 2 3 0
The Work I Do
 I can effectively use my knowledge and skill sets in 1 2 3 4 0 1 2 3 0
my job.
 My job is interesting and challenging. 1 2 3 4 0 1 2 3 0
 I have the authority to make decisions to do my job 1 2 3 4 0 1 2 3 0
well.
 I believe my work impacts the overall business. 1 2 3 4 0 1 2 3 0
Quality of My Work Life
 The physical environment I work in is good. 1 2 3 4 0 1 2 3 0
 I am able to balance my work/personal life here. 1 2 3 4 0 1 2 3 0

Issuer : HRD
Effectivity Date : 10/1/2018
Form Number : HRD-FO-031
Version : 2

Page 3 of 4
 Your view on this statement Impact on your decision to leave
Strongly Disagree Agree Strongly Don’t High Mediu Low No
Disagree Agree know m Impact
 The company’s environment and policies allow me 1 2 3 4 0 1 2 3 0
to have a good work/life balance.
Development Opportunities
 There are sufficient opportunities for me to receive 1 2 3 4 0 1 2 3 0
training.
 The training I receive meets my needs in the job 1 2 3 4 0 1 2 3 0
 Iwell.
was given sufficient opportunities to pursue my 1 2 3 4 0 1 2 3 0
career goals here.
 I believe that my career prospects, if I stayed, 1 2 3 4 0 1 2 3 0
would be good.
 The performance management process is effective. 1 2 3 4 0 1 2 3 0
 The company provides development opportunities 1 2 3 4 0 1 2 3 0
to employees with good performance and high
potential.

Are there any other issues not mentioned above that you want to express your view on and had a strong impact on your decision to leave?

Issuer : HRD
Effectivity Date : 10/1/2018
Form Number : HRD-FO-031
Version : 2

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