Separation Of Employment Form
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1Goodwill Industries of Central Florida, Inc.
Separation of Employment
After you complete this form, send it to Payroll for processing
Employment Information
Employee's First and Last Name:
Job Title:
Start (Hire) Date:
Location:
Last Day Worked:
Supervisor's First and Last Name:
Date of Exit:
Employee' Email Address:
Separation Information: Check which one applies.
_____ Discharged or ______ Voluntarily Quit
Discharged ‐ A final warning must be attached with supporting documentation
To be completed by Management
What specifically is this employee being discharged for? Provide specific dates for absence reasons. The final warning needs to be attached and it
needs to provide the final incident details that lead to separation.
Was there a previous verbal warning for the separation reason? ______ Yes or _______No
Was there a previous written warning for the separation reason? ______ Yes or ______No
Voluntarily Quit ‐ Please submit the resignation letter, if provided
The below section is for the resigning employee to complete
Why are you leaving the company?
Final Paycheck
All Final Paychecks or Direct Deposit stubs will be mailed
to the address on file unless otherwise requested below.
______ Mail to this address instead:
Employee's Signature:
Date Signed:
Supervisor's Signature:
Date Signed:
Witness's Signature:
Date Signed:
Supervisor Checklist
______Badge ______ Business Cards ______Cell Phone ______Credit Card
______Computer Checklist from Extranet Completed
Goodwill Property Returned:
______ ID Cards ______Other, Please Specify: ___________________________________________
______Locker ______ Keys to the Location(s) ______ (Number of keys returned)
Key's Returned:
______Other, Please Specify: ___________________________________________
Human Resources Processing Area ‐ Payroll
Date Separation
Form Received:
Employee ID:
How many days were between
Fax _______ Mail ________ Scan_______
How was the
the date separated and the form
separation form received?
being received?
________________ # of Days
Other: ____________________
HR Staff Initials:
Separation Code ‐ Code Reason:
Revised: February 2014
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Parent category: Business