Name:
|Employee Name: |Employee #: |Location |
|Effective Date: |Last Day Worked: |
|Termination Reason: |Eligible for re-hire? Yes No |
|Quit |Please give termination explanation: |
|Management Decision | |
|Reduction in Force | |
|Other_________________ | |
|Company Property: |Assigned |Returned |Comments |
|Vest | | | |
|Badge | | | |
|Key Fob | | | |
|Credit Card | | | |
|Cell Phone | | | |
|Laptop | | | |
|Other________________________ | | | |
|Other________________________ | | | |
|Supervisor/ |X |Date: |
|Manager | | |
For HR Use Only:
|Full-time | |401(k) | | |
|Seasonal |Pull I9 |Yes No |Notify Corp & GM |Remove from Security System |
| |
| |
| |
| |
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