Dismissal / Terminating Employee
Use this form when you need to dismiss or terminate an employee
Employee Info:
Your Client / Business Name
*
Terminating Employee Name:
*
First Name
Last Name
Terminating Employee End Date:
*
-
Month
-
Day
Year
Last day of work
Did Employee choose to leave your organization?
*
Yes - Employee is leaving voluntarily
No - Employee didn't choose to leave
Reason for Dismissal or Termination:
*
Career Advancement
Compensation
Leave of Absence
Personal Reasons
Relocation
Return to school
Type of Work
Layoff
Performance
Position Eliminated
Seasonal
Other
Reason for Termination?
When will the employees last check occur?
Immediate Payment
Included in the next payroll
Will final payment include a PTO or Sick Time payout? (Benefits will be prorated unless otherwise noted below in "Other")
Yes
No
Verify employee Personal Email address:
Employee will receive their W2 electronically via this email
Other Information:
Is there any specific information that is useful in documentation of the termating employee?
Employer Responsibility Checklist
Employer is responsible for the following changes unless otherwise noted:
Terminating the Employee from any Health Insurance coverage
Terminating the Employee from any 401k / SEP IRA / Simple IRA plan
Submit
Should be Empty: