SES Employee Separation Form

Student Employment Services Employee Separation Form
Student Name*

First NameLast Name
Student ID Number*
900 #
Today's Date*

MonthDayYear
Date
Position Code*
Title*
Department*
Supervisor Name*

First NameLast Name
Supervisor Email*
** This must be correct so they can complete next steps. example@adams.edu
I would like to...*

Resign from this positionTransfer to another position
Effective Date*

MonthDayYear
Date
Reason for Leaving & Additional Comments
Student Signature*

Clear
I have turned in my final timesheet, or will do so within two (2) business days of the effective day indicated above. I understand that if I fail to submit my timesheet in a timely manner, I may not be paid until the following pay period.

Supervisor Section- Office Use Only
Supervisor Password
Supervisor Name*

First NameLast Name
Length of Notice from Student
Eligible for Rehire*

YesNo
Job Attendance*

PoorAverageAbove Average
Student Conduct*

PoorAverageAbove Average
Comments
Start Date*

MonthDayYear
Date
Effective Separation Date*

MonthDayYear
Date
Termination

If student was terminated by supervisor/department, please provide the following information and attach appropriate documentation, as described in SES Supervisor Manual.
Reason for Termination
Date of Termination

MonthDayYear
Date
Termination Documents

Browse Files

Cancelof
Supervisor Signature*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty:

Student Employment Services Employee Separation Form