Termination/resignation Form

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TERMINATION/RESIGNATION FORM
Check One:
Full-Time
Part-Time
Student Worker
Name _________________________________
Blinn ID# ___________________
Job Title
___________________________
Department ___________________________
Campus
___________________________
Resignation
Termination
Last Day of Employment ______________________________
Reason for Resignation/Termination _______________________________________________
Eligible for Rehire
Yes
No
If No, Reason ___________________________________________________________
_______________________________________________________________________
Notes:__________________________________________________________________
_______________________________________________________________________
Approval:
__________________________________
________________
Supervisor
Date
__________________________________
________________
Vice President
Date
__________________________________
________________
Director Human Resources
Date
__________________________________
________________
VP Administrative Services
Date
__________________________________
________________
President
Date
Approved by Compensation Coordinator: Date ____________________
Revised June, 2013

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