NEW Explanation of Termination Form
Your Name
*
First Name
Last Name
Employee Name
*
First Name
Last Name
Department Number
*
Today's Date
*
-
Month
-
Day
Year
Date
Type of Separation
*
Voluntary Quit
Lay-off
Termination
Leave of Absence
Illness/Injury
Voluntary Quit
Other work
Relocation
Health
Working Conditions
Other
Termination
Unreported Absences
Not Qualified/Meeting standards
Positive Drug Test
Violation of Company Rules/Policies
Refusal to Follow Instructions
Tardiness
Insubordination
Other
Lay-off
Seasonal
Temporary
Permanent- Position no longer exists
Illness or Injury
Work related
Non-work related
Return of Company Property
If this doesn't apply, you can skip this section.
Company property collected
Phone
Tablet
Visa Card(s)
Fuel Card(s)
Uniform
Key(s)
Other
Final Remarks
Eligible for Rehire?
*
Yes
No
Yes, but not to my department.
Please explain why.
Notes:
Your signature
*
Submit
Should be Empty: