Termination
Name
*
First Name
Last Name
Termination Date
*
/
Month
/
Day
Year
Date
Reason For Termination
*
Layoff
Resigned
Fired
Job Abandonment
Eligible for Rehire
*
Yes
No
Explanation
*
Items to be Returned Upon Termination
*
Keys
Phone
Home Depot Card
Gas Card
Uniforms
Tools
Access Card
Other
Employee Signature
*
Employee Name
First Name
Last Name
Supervisor Signature
*
Supervisor Name
First Name
Last Name
Submit
Should be Empty: