Employee Termination Form

Employee Termination Form
Today's Date*

MonthDayYear
Date
Employee Name*
Manager Name*
Termination Date*

MonthDayYear
Date
Last Date Worked*

MonthDayYear
Date
Reason for Termination of Employment*
Disciplinary Action(s) Prior to Termination*
Is employee eligible for rehire?*
Did employee return badge and shirt?*
If not, what items do they still have:
Explanation:*
Employee Acknowledgement:

My signature indicates that this notice has been discussed with me and that I understand it's contents.
Employee Signature

Clear
Date

MonthDayYear
Date
Manager Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: