Microsoft Forms

1
2
Client Name * This field is required.
3
Your Name * This field is required.
4
Your Email Address * This field is required.
5
Employee Name * This field is required.
6
Last Date Worked * This field is required. The last day on which the employee actually performed any work for your company.
Date
Month
Day
Year
7
Date of Termination * This field is required.This date may be the same as or different than the employee's Last Date Worked.
Date
Month
Day
Year
8
Eligible for Rehire?* This field is required.
YESNO
9
Termination Type * This field is required.
Voluntary
Involuntary
10
Termination Reason* This field is required.If none of the available termination reasons are entirely accurate, choose the one that is most accurate. Use "Other" only as a last resort.
Please Select
Please Select
At Will/Not a Good Fit
Conviction of a Crime
Deceased
End of Assignment
Failed Drug Test
Failure to Maintain License or Certification
Failure to Return from Leave
Harassment or Violence
Insubordination
Job Abandonment
Lack of Work or RIF
Mutual Separation Agreement
Relocation
Resigned - Career Growth or Opportunities
Resigned - Health Reasons
Resigned - Not Enough Hours
Resigned - Manager Dissatisfaction
Resigned - Other
Resigned - Pay or Benefits
Resigned - Personal Reasons
Resigned - Return to School
Resigned - Schedule
Resigned - Working Conditions
Retired
Theft of Company Property
Unacceptable Attendance
Unacceptable Performance
Unacceptable Performance - Did not comply with PIP
Violation of Company Policies
Workplace Violence/Threats
Other
Should be Empty: