Employee Termination Form
Employee Name
*
Department
*
Please Select
Office
Sales
Service
Logistics
Production
Position Title
*
Supervisor Name
*
Supervisor E-mail
*
charles@cleanslategrp.com
GCiallella@cleanslategrp.com
GFriedman@cleanslategrp.com
JAlfaro@cleanslategrp.com
jacob@cleanslategrp.com
JUllom@cleanslategrp.com
jpaige@cleanslategrp.com
lSchiadaresis@cleanslategrp.com
LEspana@cleanslategrp.com
mkatzwer@cleanslategrp.com
MPatel@cleanslategrp.com
MOtero@cleanslategrp.com
mlaitman@cleanslategrp.com
PFonda@cleanslategrp.com
SGignoux@cleanslategrp.com
TWilson@cleanslategrp.com
mbynoe@cleanslategrp.com
yfried@cleanslategrp.com
rkrublit@cleanslategrp.com
shurff@cleanslategrp.com
baltman@cleanslategrp.com
Termination Effective Date
*
-
Month
-
Day
Year
Date Picker Icon
Last Day of Work
-
Month
-
Day
Year
Date Picker Icon
Property & Equipment to Return
Check
Gas Card
EZ Pass
Home Depot Card
Keys
Cell Phone
IPad
Vehicle
Supplies
Property & Equipment: Other
IT & Access Privilages
Check
Email
SAP
Computer
Iphone Voicemail
Desk Voicemail
Email
Check
Reset Password
Add Auto Reply
Forward 30 days
Remove from groups
Iphone Voicemail
Check
Reset password
Update Voice Message
Forward for 30 days
Desk Voicemail
Check
Reset Password
Update Voice Message
Termination Type
*
Please Select
Voluntary
Not Voluntary
Reason
*
Please Select
Dissatisfied with Work
Retirement
Returned to School
Relocation
Personal Circumstances
In Lieu of Discharge
No Reason Given
Other
Reason
*
Please Select
Attendance
Job Abandonment
Didn't Meet Performance Expectations
Insubordination
Not Qualified for the position
Gross Misconduct
Dishonesty of Theft
Death
Lack of Work
Job Eliminated
Elimination of Position
Reduction in Staff
Other
Supervisor Statement
*
Rehire Status
Please Select
Eligible
Not Eligible
Submit
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