Resignation Form For Voluntary Separations printable pdf download

Resignation Form for Voluntary Separations

(To be completed by employee, signed by supervisor, and forwarded to Director)

Employee Name:

Date Submitted:

Employee Title:

Last Day Worked:

Region/County:

I submit my resignation from my position with the University of Missouri Extension. I have read and understand the

following:

1) For non-academic positions: Accrued unused vacation time will be transferred with me if I am transferring to another

University of Missouri department with no break in service or, if not continuing employment with UM, will be paid

lump sum and will not be considered as time worked for purposes of calculating overtime.

For academic positions: Accrued unused vacation time will be paid lump sum unless transferring to a non-academic

position with another MU department.

For questions or clarification of MU policy regarding vacation payments, contact your Extension Human Resources

office at 573-882-4721.

2) Unused compensatory time will be paid lump sum and will not be considered as time worked for purposes of

calculating overtime.

3) Unused personal days and sick time are not compensable. The use of personal days and sick time between now and

my last day worked must be approved by my supervisor, and may only be approved under extenuating circumstances.

I understand that I may be requested to submit a doctor note for any sick days requested.

4) I will be removed from the payroll on the last day of actual work except in the case of retirement. Medical and dental

benefit eligibility continues until the end of the month of termination. Questions regarding University benefits,

COBRA, and retirement may be directed to 573-882-2146.

5) I must return to the University of Missouri those items listed by my supervisor, director, or designee such as

University equipment, computer, email password, etc. Failure to return items may result in a delay of my last

paycheck. See separation checklist for potential items to be returned.

6) I may be requested to complete an Exit Survey and/or Exit Interview with my supervisor, director, or human resources

associate; If not contacted, I have the option to request an exit interview by contacting MU Extension Human

Resources at 573-882-4721.

7) At least two (2) weeks notice is required when an employee wishes to resign his/her position in good standing, unless

supervisor has agreed to a shorter period of notice.

The main factor(s) which contributed to my decision to begin looking for employment elsewhere are:

Resignation Form For Voluntary Separations