Employee Separation Form printable pdf download

California State University Fresno

EMPLOYEE SEPARATION FORM

All employees* separating from California State University, Fresno employment must complete this form. Written notification of

separation must be received by the appropriate Personnel Office at least 2 weeks prior to the last day worked (as soon as possible if

less than 2 weeks notice is given). In separating from California State University, Fresno, an employee must return all State property

checked out while employed. Clearances must be completed by the last day on Campus in order for the Payroll Office to complete the

document necessary to issue final pay. A list of the departments has been provided for your convenience in this clearing process.

Should you have questions on returning any item assigned to these offices, please call the appropriate individuals as noted:

EMPLOYEE NAME:

FRESNO STATE ID:

DEPARTMENT:

EMPLOYEE TYPE:

EFFECTIVE DATE OF SEPARATION:

LAST DAY PHYSICALLY WORKED:

Faculty*

Management

Staff

*Part Time Faculty separating at the end of a semester are not required to complete this form. The clearance process for Part Time Faculty

separating at the end of a semester will be handled by the Payroll Department.

FERP – Faculty members intending to FERP – see back of form for additional information.

REASON FOR SEPARATION:

Resignation – Send Letter Immediately To Appropriate Personnel Office

Faculty must provide letter of resignation to Academic Personnel, Thomas Administration, Room 118, fax number 559-278-8190

Staff or Management must provide a letter of resignation to Employment and Benefit Services, Joyal Administration Room 164, fax number 559-278-4275)

End of Temporary Assignment

Retirement

(Staff and MPP employees should have already provided Benefits with a letter of retirement; faculty should have submitted letter to Academic

Personnel)

Other (please specify):

Contact person

Applicable to

Signature of clearing

Date

Item to return

Department

You

department

Cleared

Parking decal

Cashier Window–

Shirley @ 8-6143

Yes

Joyal Bldg.

(sstaton)

Retiring employees should contact Employment and Benefits Office for information regarding maintaining a parking decal

Petty Cash

ACCTNG -

Carol @ 8-6775

Yes

Joyal Adm Rm 181

CSUF American

ACCTNG -

Chris @ 8-5476

Express

JA Room. 152

(chrisa)

Yes

Gov’t Charge Card

Campus ID Card

Public Safety –

Jeanie @ 8-2172

Yes

Campus Keys

Keats Bldg.

(jeaniea )

Multimedia

AIC Classroom Services –

Jeanne @ 8-2674

Yes

equipment

Industrial Tech Room 156

Telephone calling

Info. Technology Svcs

Eman @ 8-5063

Yes

card

(ITS)– MCF Room 137

Retiring employees will be allowed to maintain their email account. ITS will automatically delete E-mail and authorization codes for all other separating employees.

Library Material

LIBRARY – circulation

Sue @ 8-2551

Yes

Retiring employee(s) requesting retention of library privileges should contact the Library directly to provide required information and request extension of privileges

ProCard,

PURCHASING-

Judy @ 8-2111

Dept. charge card

Joyal Adm Room 161

Yes

must be returned

Department Specific

EMPLOYEE DEPARTMENT –

Cell Phone

Grade Books

Department Technician