Employee Exit Procedure Form - Marymount Commons

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Employee Exit Procedure Form
Employee Name:
Title:
Last work date:
(00/00/00)
Forwarding Address: ___________________________________________________________________
I. To be completed by the Department Head:
Personnel Action Form forwarded to HR Services
Date
Letter of resignation/termination forwarded to HR Services
Date
II. To be completed by the Employee and returned to the Department Head:
The employee has returned the following items:
Signature & Date
YES
N/A
(Please print)
ID card (Auxiliary Services)
Parking tag/Tickets paid (Auxiliary Services)
Laptop/peripherals/other computer equip. (ITS)
Credit card(s) (Business Office)
Library materials returned/fines paid (Library)
Outstanding balances cleared (Student Accounts)
Door key(s) and/or key card(s) (Physical Plant)
Cell phone (Department Head)
University records and/or manuals (Department Head)
Locker key (Department Head)
Tools (Department Head)
Uniform (Department Head)
Badge (Department Head)
Other (Department Head)
Other (Department Head)
Employee
Signature
Date
Department Head
Signature
Date
Please forward this form to HR Services upon completion and remind the employee to contact HR
Services with benefits questions.
Human Resource Services Use Only
HR Services
Forwarded to Payroll
Signature
Date
Date
10/07

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