Termination Notification Form

Termination Notification Form
Employee Information
Employee Name
Employee #
Position
Division
Term Date (Effective)

MonthDayYear
Date
Termination Details
Type of Termination

VoluntaryInvoluntary
Eligibility for Rehiring

Eligible for RehireNot Eligible for Rehire
Reason for Termination
Administrative Items
Company Property Returned

LaptopiPadCredit CardKeyfob (building access)Company Vehicle / KeysOther
Manager Certification

I certify that the information provided in this form is accurate and complete to the best of my knowledge.
Manager Signature

Clear
Should be Empty:

Employee Information