"Employee Separation Form"

ADVERTISEMENT
ADVERTISEMENT

Download "Employee Separation Form"

249 times
Rate (4.8 / 5) 15 votes
Employee Separation Form
Employee:
Date:
Position:
Start Date:
Email:
Phone:
Address:
q Voluntarily left due to:
q New position q Relocation/Transfer q Medical Condition q School
q Conflict with superior/coworker/schedule/pay:
q Retirement q Personal q Other:
q Involuntarily left due to:
q Tardiness q Absenteeism q Insubordination q Unsatisfactory Work
q Job eliminated/changed q Lack of Work q Disability
q Other
Explanation:
Employee Statement:
Separation is: q Temporary q Permanent
Work will resume on:
Employee is eligible for rehire?
q Yes q No
If no, why not:
Employee Received:
q Severance Pay
q Wages in Lieu of Notice
q Bonus
q Profit Sharing
Payment Type:
Payment Amount:
Period:
Employer:
Account No.
Position:
Start Date:
Email:
Phone:
Address:
Employee Signature
Date
Employer Signature
Date
www.BusinessFormTemplate.com
Employee Separation Form
Employee:
Date:
Position:
Start Date:
Email:
Phone:
Address:
q Voluntarily left due to:
q New position q Relocation/Transfer q Medical Condition q School
q Conflict with superior/coworker/schedule/pay:
q Retirement q Personal q Other:
q Involuntarily left due to:
q Tardiness q Absenteeism q Insubordination q Unsatisfactory Work
q Job eliminated/changed q Lack of Work q Disability
q Other
Explanation:
Employee Statement:
Separation is: q Temporary q Permanent
Work will resume on:
Employee is eligible for rehire?
q Yes q No
If no, why not:
Employee Received:
q Severance Pay
q Wages in Lieu of Notice
q Bonus
q Profit Sharing
Payment Type:
Payment Amount:
Period:
Employer:
Account No.
Position:
Start Date:
Email:
Phone:
Address:
Employee Signature
Date
Employer Signature
Date
www.BusinessFormTemplate.com