Employee Termination Form Your Name(Required) First Last Your email address(Required) Please Select:(Required) Status Change Termination Medical Leave Employee InformationEmployee Name(Required) First Last Is the employee's address we have on file correct? Or will they be moving?(Required) Address we have is correct They are moving I do not know Enter their new address(Required) Street Address City State / Province / Region ZIP / Postal Code Employee Phone Number(Required)Position(Required) Motorcoach Operator Cleaner / Detailer Mechanic Office Staff Full-Time / Part-Time(Required) Full Time Part Time Employee TerminationHire Date(Required) MM slash DD slash YYYY Last Day Worked MM slash DD slash YYYY Termination Date(Required) MM slash DD slash YYYY Reason for TerminationUntitled(Required) Voluntary Involuntary Going to Work For (list below) Retirement Going back to school Moving out of town Military Leave End of temporary employment Other - please describe: General DocumentationCheck all items that you have recovered:(Required) CLC Card Credit Card Office/Mailbox Keys Cell Phone GreenRoad Dallas Key None of the above Eligible for Re-Hire(Required) Yes No Did the employee provide 2 weeks notice and fulfill it?(Required) Yes No Other Items to Check Vacation Health Insurance Other Benefits Status ChangeChange Status: Move to Full-Time Move to Part-Time Change Hourly Rate Other - see below Effective Date for Change: MM slash DD slash YYYY MUST be start of new pay period.Enter New Hourly Rate:List details explaining change:Medical LeaveMedical Leave Status(Required) Going on Medical Leave Coming off Medical Leave Medical Leave Start Date(Required) MM slash DD slash YYYY Estimated Medical Leave End Date(Required) MM slash DD slash YYYY Return Date(Required) MM slash DD slash YYYY Notes-Comments:
