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Employee Termination Form

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EMPLOYEE TERMINATION/LEAVE FORM

Employee Name:
Job Title:
Department:
Manager:
Termination Date:

Reason for Termination/Leave


Voluntary

Involuntary

[ ] Another Position

[ ] Illness or Injury Attendance

[ ] Personal Reasons

[ ] Violation of Company Policy

[ ] Relocation

[ ] Lay Off

[ ] Retirement

[ ] Reorganization

[ ] Return to School

[ ] Position Eliminated Strike or Lockout

[ ] Other__________________________
EFFECTIVE DATE OF
TERM/LEAVE
YYYY/MM/DD

[ ] Other__________________________

LAST DAY WORKED

RETURN DATE

YYYY/MM/DD

YYYY/MM/DD

Comments:

Employee's Signature _____________________________________________


Interviewer's Signature ____________________________________________
Date ________________________________________________________________

ELIGIBLE FOR REHIRE


(IF TERMINATED)
YES [ ] NO [ ]

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