CDS Termination of Employment Form

CDS Termination of Employment
Employer Name (Client or Legally Designated Employer)
If the employer is the client, but the client uses a Designated Representative for signing purposes, please put client name here.
Employer Email Address
The confirmation and copy of this form will be sent here.
Employee/Attendant Name
This is the person whose employment is being terminated.
Program
Termination Date

MonthDayYear
Date
Last Date Actually Worked

MonthDayYear
Date
Date of Last Issued Pay Check

MonthDayYear
Date
Other than the Final Check, is additional pay due on the Termination Date Listed Above?
If YES, Check One

Other
If YES, Check One

Other
NOTE: If a Final Check is due, a completed Timesheet must be submitted to HRA via the electronic timesheet form 1 (one) working day before the Termination Date listed above.
Reason for Termination
LAY OFF
VOLUNTARY RESIGNATION

Other
INVOLUNTARY TERMINATION

Other
NOTE: Involuntary Termination must be supported by one of the following:
- Employee Performance Appraisal Form 1732 (Jotform Fillable)
  - This will open a new fillable Jotform that will email you a pdf once you are finished. You can upload the pdf it provides for supporting documentation.
- Form 1732 (Adobe Download)
  - In order to save the Adobe version above, please Right-click -> Save As
- Or other proper disciplinary documentation.
Supporting Documentation (Please submit one of the documents listed above)

Please submit as a .pdf file
Cancelof
Comments/Instructions
Employee/Attendant Signature
Employer Signature
Date

MonthDayYear
Date
Submit Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Should be Empty: