Departure Notification Form
Name of Employee Leaving
First Name
Last Name
Is employee retiring?
Yes
No
Department
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Hire Date
-
Month
-
Day
Year
Date
Last Day to Work
-
Month
-
Day
Year
Date
Has an exit interview with the Dean been scheduled?
Yes
Will contact Janet Stork to schedule
Please upload a copy of the resignation/retirement letter.
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