EXIT Clearance Form

Instructions: This form is to be used as part of the exit procedures for all staff. Department Heads/ Team
Leaders are to ensure this form is completed and submitted to HR and Finance Department before the
employee leaves Cardno Myanmar. Final salary payment is subject to the satisfactory completion of this
Staff Exit Form.

PERSONAL DETAIL
Name:

Position:

Duty station:

Joined date of employment: Date of duty relinquished:

Email:

Contact Address:

Admin & Logistics Clearance:

I certify that:
Computer/Tablet have been handed over and accounted for
Official documents, login and passwords have been returned/cancelled/reset
Mobile, Radio and charger battery have been returned
All office keys have been returned
Motor Cycle have been returned
Helmet Have been returned
Others (please state):

Name & Position: ------------------------------------------ Signature & Date: ------------------------------------------

HR Clearance:

I certify that:
Letter of resignation/termination is on file
Debriefing questionnaire form have been completed
Final time sheet has been completed
Final Leave form has been completed
Others (please state):

Name & Position: ------------------------------------------ Signature & Date: ------------------------------------------

Finance Clearance:

I certify that there is no outstanding amount owning from the above employee in relation to:

Telephone costs Field allowance Bank signatory removal

Project related expenses Other cash advance Others (please state):

Staff 1: Staff 2:
Name & Position: ------------------------------------------ Name & Position: ------------------------------------------

Signature & Date: ------------------------------------------ Signature & Date: ------------------------------------------

Handover received by Line Manager/ Colleague:

Staff 1: Staff 2:
Name & Position: ------------------------------------------ Name & Position: ------------------------------------------

Signature & Date: ------------------------------------------ Signature & Date: -----------------------------------------

EMPLOYEE CERTIFICATION (Departing Employee to sign)

I hereby certify that I have completed all the necessary action required prior to my departure and that I have
returned all Cardno owned equipment and material previously held in my position (including mobile, battery
charger, computer hardware, software, manuals, stationary and field equipment).

Signature and date: ----------------------------------------