Employee Termination Form

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EMPLOYEE TERMINATION/LEAVE FORM

Employee Name:

Job Title:

Department:

Manager:

Termination Date:
Reason for Termination/Leave
Voluntary Involuntary
[ Another Position [ Illness or Injury Attendance
] ]
[ Personal Reasons [ Violation of Company Policy
] ]
[ Relocation [ Lay Off
] ]
[ Retirement [ Reorganization
] ]
[ Return to School [ Position Eliminated Strike or Lockout
] ]
[ Other [ Other
] ]

EFFECTIVE DATE LAST DAY RETURN DATE ELIGIBLE FOR REHIRE


OF TERM/LEAVE WORKED (IF TERMINATED)
YYYY/MM/DD YYYY/MM/DD YES [ ] NO [ ]
YYYY/MM/DD

Comments:

Employee's Signature

Interviewer's Signature

Date

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