Employee Exit Form

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DFE-E
Fort Bend ISD Human Resources Department
EMPLOYEE EXIT FORM
Important Information: Completion of this form indicates your voluntary resignation from FBISD (not just from
your campus/department). Do not complete this form if you will transfer to another work location or campus.
Today’s Date: _____________________
Name: __________________________________ SS#: ____________________ Employee ID#: ________________
I submit my resignation from employment with FBISD effective _____________. This will be my last day reporting
to work. I am leaving the District because __________________________________________________________
____________________________________________________________________________________________.
Your final paycheck, and in some instances the last two, will be mailed; therefore, please provide an updated
address below.
Permanent Address (COBRA information will be mailed to this address):
Street: _____________________________City: _________________State: ________________ Zip: ___________
Telephone Number: ______________________ Campus/Department currently assigned to: __________________
My signature below acknowledges I understand and will comply with the following:
Permanent Address is required to receive official communications from the District,
final paycheck, and other documents I request.
I have returned all District property and Exit Interview Form.
My benefits coverage will end when my last paycheck is issued.
NOTE: All Chapter 21 employee resignations submitted mid-year or after the penalty-free
resignation deadline require approval from the Superintendent or Board-appointed
designee before the employee can be released.
Employee Signature: _________________________________________ Signature Date: _____________________
Principal/Hiring Manager Acknowledgement: _____________________ Exit Interview Completed: Yes___ No___
HR Receiving Staff: _________________________________________ HR Receipt Date: ____________________
12/14SB

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