Termination Form printable pdf download

THIS FORM IS MANDATORY FOR ALL

TERMINATIONS

Termination Form

Company Name: __________________________

Employee Name: _________________________________

SS #: ____________________ Date of Separation

Reduction of Hours: _____________ Last Day Worked: _____________

Yes

No

Is employee eligible for rehire?

Yes

No

Final Check Required?

Deactivate the employee’s Direct Deposit for the final check?

Yes

No

Hours to be paid: Regular: ______ Overtime: ______

Severance Pay

Vacation Pay

Other Adjustments____________

Yes

No

Will Employee Receive Retirement Benefits?

Updated Address for Employee: ____________________________________________________________________________________

Supervisor's Signature: _______________________________________ Date: ________________________

REASON FOR TERMINATION

QUIT Attach Resignation Notice if Provided

****Must be Faxed Upon Notification****

Check ONE that best applies:

Other job

Medical / Maternity

Personal (specify)_________________________

Job Abandonment (No show)

Moving

Conflict (specify)_________________________

Education

Working Conditions (specify)_______________

Mutual Agreement

Retirement

Other (please specify)________________________________________________________________

TERMINATION Attach Related Documentation

****Must be Faxed Prior to Termination****

Check ONE that best applies:

Layoff

Suspected Theft

Seasonal / Temp. Job Ended

Violation of Policy

Death

Unacceptable Background Check / Drug Screen Results

Excessive Absences or Tardy

Termination of Client Contract

Job Performance

Failure to Provide Required Identification

Gross Misconduct

Other (specify)______________________________________

Were any warnings given?

Yes

No (Please send any supporting documentation, i.e.: notes, written warnings,

disciplinary actions, etc.) Were alternatives available (ie: transfer, suspension, etc.)?

Yes

REDUCTION OF HOURS

****Must be Faxed Upon Notification****

How many hours did this employee normally work each week? __________



Has the number of hours per week recently been reduced?

Yes



Did this employee request a reduction in hours?

Yes

Please remember to attach required documentation and fax to the Payroll Department at ESG within required

timeframe detailed above.

Fax to (801)-223-9001, (801)-226-2046 or toll-free: (877) 374-2677

Termination Form

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