Seasonal Employment Separation Form

Seasonal Employment Separation Form
Employee Name*

First NameLast Name
Department*
Position (select all that apply)*

Aquatics- Attendant RRAquatics - Conc/Cashier RRAquatics - Guard 1 RRAquatics - Guard 2 RRAquatics - Maintenance RRAquatics - Pool Manager RRCommunity Rec - Activities RecCommunity Rec - Manager RecHarlan Rogers - Conc/Cashier HRHarlan Rogers - Maintenance HRHarlan Rogers - Manager HRHarlan Rogers - Mechanic HRLakeside - Clubhouse LSLakeside - Course Supervisor LSLakeside - Maintenance LSLakeside - Manager LSState Events
Position (select all that apply)*

Building Service Worker - Clean OutBuilding Service Worker - TemporaryLaborerMaintenance ForestryMaintenance ParksMaintenance ROWMaintenance Worker I - CemeteriesMaintenance Worker II - CemeteriesMaintenance Worker III - CemeteriesParks Technician
Position (select all that apply)*

Compost Site AttendantSeasonal Laborer - SanitationSeasonal Laborer - StreetsSeasonal Laborer - Traffic SafetySeasonal Laborer - Utility SystemsSeasonal Snowplow Operator
Separation Date*

MonthDayYear
Date
Last Day Worked (if different)

MonthDayYear
Date
Reason for Separation*

VoluntaryInvoluntaryInvoluntary - End of Season
Additional Comments
Supporting Documentation (if any)

Cancelof
Eligible for Rehire*

YesNo
Supervisor Completing Form*

First NameLast Name
Supervisor's Email*
example@example.com
Should be Empty: