EMPLOYEE DEACTIVATION

This form is no longer active. Please submit this information using our Payroll Revisions and Additions page (Employee Revisions form).

Employer Name:*
Employee Name:
Last Payday

MonthDayYear
Employee Name:
Last Payday

MonthDayYear
Employee Name:
Last Payday

MonthDayYear
Employee Name:
Last Payday

MonthDayYear
Confirmation*

The above employee(s) will be removed from the active employee list in the payroll system after their last payday.
Submitted By (Initials):*
E-mail*
Phone Number

Area CodePhone Number
Should be Empty: