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*
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 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*
- Today's Date*
  
  MonthDayYear
  Date
- Should be Empty:

Student Employment Services Employee Separation Form