Seasonal Employment Separation Form
Employee Name
*
First Name
Last Name
Department
*
Please Select
Public Areas
Public Works
Recreation Services
Position (select all that apply)
*
Aquatics- Attendant RR
Aquatics - Conc/Cashier RR
Aquatics - Guard 1 RR
Aquatics - Guard 2 RR
Aquatics - Maintenance RR
Aquatics - Pool Manager RR
Community Rec - Activities Rec
Community Rec - Manager Rec
Harlan Rogers - Conc/Cashier HR
Harlan Rogers - Maintenance HR
Harlan Rogers - Manager HR
Harlan Rogers - Mechanic HR
Lakeside - Clubhouse LS
Lakeside - Course Supervisor LS
Lakeside - Maintenance LS
Lakeside - Manager LS
State Events
Position (select all that apply)
*
Building Service Worker - Clean Out
Building Service Worker - Temporary
Laborer
Maintenance Forestry
Maintenance Parks
Maintenance ROW
Maintenance Worker I - Cemeteries
Maintenance Worker II - Cemeteries
Maintenance Worker III - Cemeteries
Parks Technician
Position (select all that apply)
*
Compost Site Attendant
Seasonal Laborer - Sanitation
Seasonal Laborer - Streets
Seasonal Laborer - Traffic Safety
Seasonal Laborer - Utility Systems
Seasonal Snowplow Operator
Separation Date
*
-
Month
-
Day
Year
Date
Last Day Worked (if different)
-
Month
-
Day
Year
Date
Reason for Separation
*
Voluntary
Involuntary
Involuntary - End of Season
Additional Comments
Supporting Documentation (if any)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Eligible for Rehire
*
Yes
No
Supervisor Completing Form
*
First Name
Last Name
Supervisor's Email
*
example@example.com
Submit
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