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Checklist of Employee Termination Action
| Date: | |
| Name: | Social Security No.: |
| Title: | Department/Location: |
| D/O/H: | Supervisor's Name: |
| 1. Voluntary Resignation: | |
| ____ Resignation Ltr. Received | ____ Adequate Notice Given (If Not, State Circumstances Why) |
| 2. Involuntary Resignation/Termination: | |
| A. Signed and Attached: | |
| ____ Management Approval Attached | ____ Separation Agreement & General Release Signed |
| B. Property Returned: | |
| ____ Computer Diskettes | ____ Company Handbook(s) |
| ____ Computer Books | ____ Pertinent Business Documents and All Copies |
| ____ Computer Keys | ____ Office Keys |
| ____ Company Car | ____ All Company Credit Cards |
| ____ Company Car Keys | ____ All Company Equipment |
| ____ Employee Identification Card(s) | |
C. Final Accounting: | |
| ____ Prior Expenses Submitted | ____ Advances/Loans Repaid |
| ____ COBRA Benefit Forms Completed | ____ 401(k)/Pension Forms Completed |
| ____ Accrued Vacation Pay Calculated & Paid | ____ Final Paycheck Issued | D. Exit Interview Conducted: |
| ____ Yes | ____ No | E. Other: | Prepared By: |
| Department Head: | Personnel Department; |
| Title/Date | Title/Date |
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