Resignation Or Termination Form - Accra Care printable pdf download

Resignation Or Termination Form - Accra Care

ACCRA CARE, INC | CONSUMER CHOICE SERVICES, INC

1011 First Street South, Suite 315, Hopkins, MN 55343, (P) 952-935-3515 (F) 952-935-7112,

Resignation or Termination Form

In case of resignation or termination of an employee this form must be completed and returned to the Accra

Office. The Responsible Party or Employee may complete this form. The completed form will serve as a letter of

resignation or termination.

Participant’s Name: _______________________________________________________________

Employee Name: _______________________________________________________________

Last day and shift employee worked: _______________________________________________________

Please indicate how the employment ended by checking one of the following four boxes:

 Employee quit with notice: length of notice (circle one)

1 week

other_______

2 weeks

 Did the employee work during the time of notice given:

yes

 Employee quit without notice

 Responsible Party ended the employment

 Other (please explain)_____________________________________________________

Please indicate the reason the employment ended by checking one of the following boxes:

 Misrepresenting experience and/or

 Employee left for pregnancy/ medical leave

qualifications

and will not return

 Poor work performance

 Employee attending school/college

 Violating agency policies

 Military Service

 Violating workplace safety rules

 Failed to return from personal/medical leave

 Tardiness/ High Absenteeism

 Resignation- moved out of area

 Conviction of a crime

 Resignation- no reason given

 Employee accepted other job

 There were no hours available

 Employee dissatisfied with job

 Other: (Please explain) ___________________________________________________

Please mail or fax completed form to Accra as soon as possible along with the final signed timesheet.

__________________________________________________

______________________

Signature of Responsible Party or Employee

Date

1 |

P a g e

Resignation Or Termination Form - Accra Care

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