Employee Separation Form

Download a blank fillable Employee Separation Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Employee Separation Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

EMPLOYEE SEPARATION FORM
Print Form
An employee will use this form upon leaving the University of Baltimore to record the return of any UB-owned property and the resolution
of any financial obligations. The employee will be held responsible for any unreturned property.
Transferring to another
EMPLOYEE
LAST DATE OF WORK
Maryland State agency?
Yes
No
DEPARTMENT
POSITION
Managers and Supervisors
Under Department/Job Required Items, check any items the employee has been issued. If the employee is being terminated
involuntarily, the manager must obtain and return the property to the appropriate office.
Employee
1.
Return any UB-owned equipment to the offices listed and settle any financial obligations. If your manager has checked any of the
boxes in the first table, you are required to return those items and obtain a release signature. If you have obtained any items from
the second table, arrange the return or payment with that office. You are encouraged to obtain signatures when returning materials.
You are responsible for repayment of any missing equipment and debts.
2.
If your address and phone number are changing, update your information in MyUB Portal (HR Self Service - My Personal
Information) and follow the links to update your address elsewhere. Failure to do so can delay your last paycheck, end of year tax
information, and benefit-related materials.
3.
Regular employees will be contacted by HR to schedule an exit interview. You are welcome to contact HR at your convenience to
schedule the interview.
4.
After you return all UB property and complete this form, bring the form and your UB ID card to the Office of Human Resources.
DEPARTMENT/JOB REQUIRED ITEMS
Action
Office
Signature (Required if box is checked by your manager)
Keys
Police Dept., x5520
UB Credit Card
Procurement, x5717
Cell phone, laptop, PDA, beeper
Your department
Uniforms
Your department
Academic Record Complete (faculty only)
Appropriate Dean's Office
University ID Card
Human Resources, x5410
I have identified which items above the employee is responsible for returning. In the event of an involuntary termination, I have obtained the items and will return
them to the appropriate office.
Supervisor/manager signature_______________________________________________ Date____________________
EMPLOYEE-OBTAINED ITEMS AND FEES
Action
Office
Release Signature
Action
Office
Release Signature
Late fees and
Parking Tickets
Law Library, x4554
x5735
borrowed items
Locker and sports
Campus Recreation,
Debts
Bursar, x4848
equipment
x5591
Late fees and
Langsdale Library,
Technology hard-
OTS Call Center,
borrowed items
x4260
ware and software
x6262
My signature serves as acknowledgment that I have returned any property owned by University of Baltimore and resolved any financial obligations. I
acknowledge I will be held financially responsible for any unreturned property that was obtained as part of my job function. I understand the University reserves
the right to recover property or the replacement cost for any damaged or unreturned property.
Employee signature__________________________________________________________ Date___________________
HR USE ONLY
Unemployment
Health Insurance
University ID
Financial Disclosure
Retirement
Reinstatement Info

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go