Exit Interview Google Form Template

EXIT INTERVIEW & SEPARATION RECORD: FORMAL INSTRUMENT

Document Control:

• Effective Date: [DD/MM/YYYY]
• Version: 1.0 (Standardized Corporate Template)
• Jurisdiction: [State/Province/Country]
• Classification: Confidential – Human Resources / Legal

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1. LEGAL NOTICE & COMPLIANCE DISCLAIMER

DISCLAIMER: This document serves as a record of an exit interview and does not constitute a legal release of claims, waiver of rights, or amendment to existing employment agreements. The responses provided herein are subject to internal audit and retention policies. Information provided is for operational feedback and risk mitigation purposes. If the departing party is subject to a Severance Agreement or General Release, those terms supersede this document.

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2. PARTIES & DEFINITIONS

• Company: [Company Legal Name], including its affiliates and subsidiaries.
• Employee: [Full Legal Name], identified by Employee ID [ID Number].
• Exit Date: The final day of active employment, confirmed as [DD/MM/YYYY].

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3. OPERATIVE CLAUSES

I. RECORD OF INTERVIEW

The Employee acknowledges that the following responses are provided voluntarily. The Company makes no representations regarding the future use of this feedback, save for internal management and operational improvement.

II. CONFIDENTIALITY & SURVIVING OBLIGATIONS

The Employee reaffirms their commitment to all post-employment obligations, including but not limited to:

1. Non-Disclosure: Continued protection of Proprietary Information and Trade Secrets as defined in the Employee’s original Employment Agreement.
2. Non-Solicitation: Adherence to any restrictive covenants regarding the solicitation of clients, customers, or personnel.
3. Return of Property: Confirmation that all [Company Name] assets (e.g., hardware, credentials, documents, access cards) have been surrendered.

III. FINAL ACCOUNTING & ASSETS

The Employee certifies that all business expenses have been submitted for reimbursement and that no outstanding advances remain against Company accounts.

IV. VOLUNTARY FEEDBACK (EXIT SURVEY)

(The Employee may provide, at their discretion, responses to the following queries):

• Primary Reason for Departure: [e.g., Compensation, Growth, Personal, etc.]
• Management/Culture Feedback: [Brief synopsis of operational or structural sentiment]
• Process Improvement: [Specific recommendation for organizational efficacy]

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4. SIGNATURES & ACKNOWLEDGMENT

EMPLOYEE ACKNOWLEDGMENT I hereby certify that the information provided is accurate to the best of my knowledge and that I have returned all company property.

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Employee Signature Date

COMPANY REPRESENTATIVE Received on behalf of [Company Name] by the undersigned authorized representative.

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Representative Name/Title Date

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5. STEP-BY-STEP EXECUTION GUIDE

1. Preparation: Upload this document as a PDF to your internal portal or convert the fields to a secure web form (e.g., Google Forms/DocuSign). Ensure the "Confidentiality" clause aligns with your specific state’s labor laws.
2. Facilitation: Conduct the interview in a private setting. If the Employee declines to answer specific feedback questions (Part 3, IV), annotate the record as "Employee Declined/Neutral" rather than leaving it blank.
3. Authentication: Use an e-signature platform (e.g., Adobe Sign, DocuSign) to enforce the audit trail of the signature. Once signed, move the document to the Employee's permanent personnel file.
4. Enforcement: Periodically aggregate the "Process Improvement" data to identify structural churn risks, but maintain the anonymity of individual respondents unless the feedback involves actionable legal/compliance violations (e.g., harassment, theft, safety risks).