Employee Discharge Form
Employee Name
*
First Name
Last Name
Last Day Worked
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is there any additional pay/severance that should be received, beyond salary owed
*
Yes
No
Please describe additional pay/severance to be paid
*
Reason for Leave
*
Voluntarily
Involuntarily
Reason for voluntary leave
*
Please Select
Relocation
Other Job Opportunity
Health
Retirement
Other
Please describe reason for voluntary leave
*
In unknown, please write "unknown"
Reason for involuntary leave
*
Please Select
Job No Longer Available
Unsatisfactory Performance
Criminal Behavior
Other
Please describe reason for involuntary leave
*
Additional Notes for HR Deprtment
*
Do you have any documents/communications/emails or other evidence, we should keep on file?
*
Yes
No
Please upload below
*
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of
Administrator Submission
Submitted by
*
First Name
Last Name
Email
*
example@example.com
Submitted Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Submit
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