Blank Employee Termination Form

2 Progress Boulevard Queensbury, NY 12804 Phone: (518) 7939825, Fax (518) 7930224

EMPLOYEE TERMINATION FORM

Employee Name: ____________________________ Employee SS#: ____________________

Client Company: ____________________________ Last Day Worked: __________________

Reason for leaving (Mark Only One): Termination Date: _________________

Voluntary Resignation (Have employee complete resignation form)

Retirement Temporary Layoff Permanent Layoff

Dismissal Job Abandonment

Explanation. Please be as detailed as possible.

__________________________________________________________________________________________

If there were multiple reasons, what was the final incident that resulted in termination?

__________________________________________________________________________________________

Reminder: Does employee have any of the following you need to collect now?

q Any keys/access cards to the building, desks, file cabinets, etc.

q Company books, credit cards, computer programs, disks, passwords, etc.

Would this employee be recommended for rehire? Yes No

Additional Comments: __________________________________________________________________

__________________________________________________________________________________________

________________________________________ ________________

Manager’s Signature Date

________________________________________ _________________

Employee’s Signature Date

To ensure accurate processing, please return to Keena Staffing within 7 days.

Fillable Printable Blank Employee Termination Form