Notice Of Employee Separation Form - Voluntary Quit
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1Notice of Employee Separation Form
VOLUNTARY QUIT
Employee Name:__________________________________________
Social Security Number: ___________________________
Job Title: _______________________________________________
Last Day Worked: ________________________________
Company: _______________________________________________
Supervisor’s Name: _______________________________
Please complete the section and questions that apply to the employee’s employment with your company. Please attach any additional
documentation.
Quit: Dissatisfied with Job, Supervisor, Co-Worker, etc. (F-J)
EE Resignation was:
Verbal
Written
Who did EE notify of quit:
Position:
What reason was given for the quit:
Prior to resigning, did EE complain to the Supervisor or seek some resolution:
Yes
No If yes, please explain in the Comments section
Quit: Unable to Work- Medical or Family (d-j)
EE Resignation was
Verbal
Written
Who did EE notify of quit:
Position:
If EE quit because of own medical problems, was a leave requested first:
Yes
No
Was a leave available:
Yes
No
Did EE exhaust all available leaves prior to quit:
Yes
No
Did EE quit to provide care for someone else:
Yes
No
If EE was unable to work due to medical restrictions, was light duty work available or offered:
Yes
No
None Available
Quit: Abandoned Job (9)
Did EE advise anyone of decision to quit:
Yes
No
If yes, who:
Did anyone attempt to contact EE to determine work status:
Yes
No
If yes, who:
What dates did EE fail to call or report to work:
Did EE offer an explanation why they stopped reporting to work:
Yes
No
If yes, please explain in the Comments section
Quit: Domestic Circumstances (B)
Did EE quit to join the other spouse who has moved:
Yes
No
Did EE quit to provide care for children:
Yes
No
Quit: Other Job (C)
Did EE quit to accept another job:
Yes
No
If yes, please provide the name of the new employer:
Retirement (K)
Did EE choose to retire from your company:
Yes
No
Quit: Comments Section
Describe any other reasons offered for the quit and what if any actions were taken by your company to continue the employment relationship:
Completed By: __________________________________________________
Title: ______________________________
Signature: _______________________________________________________
Date: ______________________________
URGENT
: Please fax this form immediately to Sunwest Employer Services Inc., Fax Number: 602-778-9857
***PLEASE DISCARD THE OLD NOTICE OF EMPLOYEE SEPARATION FORMS**
th
3707 N. 7
St. Suite #300, Phoenix, AZ 85014 Phone 602-778-9856 Fax 602-778-9857
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