Voluntary Termination Checklist Template

ADVERTISEMENT
Termination Check List – Voluntary Termination
Employee Exit Review* – Employee completes the Employee Exit Review form and returns to
Supervisor or HR representative prior to or on last day of employment.
Voluntary Resignation Form* – Employee completes the form and returns to Supervisor or HR
representative prior to or on last day of employment.
Supervisor’s Exit Reference Evaluation* – Supervisor completes and presents the Exit Reference
Evaluation to the departing employee on or before the last day of employment. Employee must sign one
of the two releases provided on the form.
Explain the Conclusion of Health, Life, Voluntary Life Benefits
 Health and Voluntary Term Life - Notify the participant of their right of conversion to an
individual bill-at-home insurance policy.
 Unum Life Insurance – Election of Portable coverage Form.
 Unum Life Insurance – Rate Form.
 Termination of Coverage Form.
 Exit Date Check List: Follow the flow charts below according to the employee’s decision
regarding conversion insurance.
List A
a.
for those individuals that are not interested in conversion insurance
List B
b.
for those individuals that are interested in conversion insurance options.
List A
– Employee does not want conversion insurance options.
 Go to BAS web page at myenroll.com and put employee termination date into
system. Notify payroll payroll of termination.
 Fill in the termination date in the appropriate boxes.
 Collect all health, vision and dental identification cards and destroy
List B
– Employee wants to consider conversion insurance options
 Health Insurance Continuation – Advise the employee to contact JLBG @ 1-
866-860-4382 within 30 days from the date of termination to apply for an
individual medical policy. Benefits for these policies are generally more
restrictive and premiums may be higher or lower than the diocese health insurance
premiums.
 Voluntary Term Life - Employee may contact JW Terrill 800-279-7728 for an
option to convert basic term life and Voluntary Term Life to an individual policy
issued by Unum within 30 days of the date of termination.
 Collect all health, vision and dental identification cards and destroy.
*Forms are available at
www.dio.org
Administration/Office for Human Resources/HR Documents.
19
Termination Check List – Voluntary Termination
Employee Exit Review* – Employee completes the Employee Exit Review form and returns to
Supervisor or HR representative prior to or on last day of employment.
Voluntary Resignation Form* – Employee completes the form and returns to Supervisor or HR
representative prior to or on last day of employment.
Supervisor’s Exit Reference Evaluation* – Supervisor completes and presents the Exit Reference
Evaluation to the departing employee on or before the last day of employment. Employee must sign one
of the two releases provided on the form.
Explain the Conclusion of Health, Life, Voluntary Life Benefits
 Health and Voluntary Term Life - Notify the participant of their right of conversion to an
individual bill-at-home insurance policy.
 Unum Life Insurance – Election of Portable coverage Form.
 Unum Life Insurance – Rate Form.
 Termination of Coverage Form.
 Exit Date Check List: Follow the flow charts below according to the employee’s decision
regarding conversion insurance.
List A
a.
for those individuals that are not interested in conversion insurance
List B
b.
for those individuals that are interested in conversion insurance options.
List A
– Employee does not want conversion insurance options.
 Go to BAS web page at myenroll.com and put employee termination date into
system. Notify payroll payroll of termination.
 Fill in the termination date in the appropriate boxes.
 Collect all health, vision and dental identification cards and destroy
List B
– Employee wants to consider conversion insurance options
 Health Insurance Continuation – Advise the employee to contact JLBG @ 1-
866-860-4382 within 30 days from the date of termination to apply for an
individual medical policy. Benefits for these policies are generally more
restrictive and premiums may be higher or lower than the diocese health insurance
premiums.
 Voluntary Term Life - Employee may contact JW Terrill 800-279-7728 for an
option to convert basic term life and Voluntary Term Life to an individual policy
issued by Unum within 30 days of the date of termination.
 Collect all health, vision and dental identification cards and destroy.
*Forms are available at
www.dio.org
Administration/Office for Human Resources/HR Documents.
19
Termination Check List
403b and Aflac – Advise the employee to contact the 403b and Aflac representatives, if applicable.
Pension – Refer employee to the Lay Employees Pension Plan Summary Description located on the
Insurance Office web page at
www.insurance.dio.org
. If the employee does not have access to the
internet then you can print out a copy from the web page. Notify employee of pension status (i.e., if
they are vested, when they can begin collecting their pension, etc.).
Date to expect last pay check - Paid at the time of separation if possible and no later than the next
regularly scheduled pay day.
Final Compensation - Final compensation includes, wages, salaries, earned commissions, earned
bonuses and the monetary equivalent of earned vacation. An employee may request that the final
paycheck be sent by mail.
Deductions from final pay – Deductions cannot be made from the employee’s pay (i.e., for loans of
money owed to the employer or purchases not paid in full or failure to return church property) without the
free written consent of the employee at the time of the deduction. As a general rule any amount that is
deducted from a nonexempt employee must not put the employee’s wages below the current minimum
wage ($8.25 as of 07/01/2010).
Repayment of Cash Advances – If the employee owes an amount that is more than 15
percent of his or her final gross wages, that amount may be withheld from the final paycheck, but only if
such an arrangement was specifically included in a prior agreement.
Severance – If severance has been promised it must be paid according to the terms of
the commitment made to the employee.
Church/School/Office Property - Request church keys or other property belonging to the employer
be turned in upon termination.
Reference – With written authorization from the employee references will be released
with remarks confined to job performance-related issues.
Service Letter – document provided to an employee by a former employer describing the nature and
duration of services provided by the employee and reason for termination. This is an efficient way of
providing departing employees with basic verification of employment information that they can pass on to
potential future employers.
Termination checklist completed for employee __________________________________________.
________________________________________________
_____________________
Parish/School/Agency/Office Representative
Date
20

Download Voluntary Termination Checklist Template

189 times
Rate
4.8(4.8 / 5) 13 votes
ADVERTISEMENT
Page of 2