"Employee Separation Checklist" - Kansas

Employee Separation Checklist is a legal document that was released by the Kansas Adjutant General's Department - a government authority operating within Kansas.

Form Details:

  • Released on January 1, 2009;
  • The latest edition currently provided by the Kansas Adjutant General's Department;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Kansas Adjutant General's Department.

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Employee
Separation
Checklist
The Adjutant General’s Department
State Human Resources
Employee Name: __________________________
Last Day at Work: ____________________
Supervisor: ______________________________
Work Site: __________________________
Employee
A.
you will be sent an Employee Exit Interview. Please complete it and return it to State
Human Resources (SHR) as soon as possible in the envelope provided.
Complete the following by the employee’s final day at work. The person approving each item must
B.
initial and date.
Date Int
_____ _____ Contact State Personnel Security Manager for De-Briefing of Employee (785) 274-1067
_____ _____ Complete and return Supervisor Exit Questionnaire to State Human Resources.
_____ _____ Complete, sign and submit timesheet to State Human Resources.
_____ _____ Notify local Information Technology of employee’s last day.
Notify Security (#1155) of employee’s last day.
_____ _____
(State Headquarters Complex)
_____ _____ Notify worksite Telephone Manager of employee’s last day.
_____ _____ Do final check on status of work projects, files, etc.
_____ _____ Return all agency issued property. (Put N/A if not applicable):
Either the employee or supervisor (designee) must return items to the appropriate control entity.
_____ _____ Keys
_____ _____ Prox Card
_____ _____ Cell Phone
_____ _____ Lap Top
_____ _____ CAC Card
_____ _____ KANSAN Phone Card
_____ _____ Uniforms
_____ _____ Corporate Credit Card
_____ _____ Tools
_____ _____ Other __________________
_______________________________________
_____________________________________
Employee Signature
Date
Supervisor Signature
Date
Submit this completed form and enclosed documents to State Human Resources within 48 hours of employee’s separation.
Questions should be addressed to (785) 274-1391, or 1460.
New 03-01-2001/Rev:03/04;
01/09
Employee
Separation
Checklist
The Adjutant General’s Department
State Human Resources
Employee Name: __________________________
Last Day at Work: ____________________
Supervisor: ______________________________
Work Site: __________________________
Employee
A.
you will be sent an Employee Exit Interview. Please complete it and return it to State
Human Resources (SHR) as soon as possible in the envelope provided.
Complete the following by the employee’s final day at work. The person approving each item must
B.
initial and date.
Date Int
_____ _____ Contact State Personnel Security Manager for De-Briefing of Employee (785) 274-1067
_____ _____ Complete and return Supervisor Exit Questionnaire to State Human Resources.
_____ _____ Complete, sign and submit timesheet to State Human Resources.
_____ _____ Notify local Information Technology of employee’s last day.
Notify Security (#1155) of employee’s last day.
_____ _____
(State Headquarters Complex)
_____ _____ Notify worksite Telephone Manager of employee’s last day.
_____ _____ Do final check on status of work projects, files, etc.
_____ _____ Return all agency issued property. (Put N/A if not applicable):
Either the employee or supervisor (designee) must return items to the appropriate control entity.
_____ _____ Keys
_____ _____ Prox Card
_____ _____ Cell Phone
_____ _____ Lap Top
_____ _____ CAC Card
_____ _____ KANSAN Phone Card
_____ _____ Uniforms
_____ _____ Corporate Credit Card
_____ _____ Tools
_____ _____ Other __________________
_______________________________________
_____________________________________
Employee Signature
Date
Supervisor Signature
Date
Submit this completed form and enclosed documents to State Human Resources within 48 hours of employee’s separation.
Questions should be addressed to (785) 274-1391, or 1460.
New 03-01-2001/Rev:03/04;
01/09