Fillable Printable Employee Exit Clearance Checklist Form - Texas Southmost College
Fillable Printable Employee Exit Clearance Checklist Form - Texas Southmost College
Employee Exit Clearance Checklist Form - Texas Southmost College
80 Fort Brown • Brownsville, Texas 78520 • (956) 295-3770 • Fax (956) 295-3384 •
www.tsc.edu
The College District prohibits discrimination, including harassment, against any employee on the basis of race,
color, religion, gender, national origin, age, disability, or any other basis prohibited by law.
Employee Exit Clearance Checklist
This form should be completed during normal working hours on your last working day.
(Please Print)
Employee Name:______________________________________________________
Department Name Account # Termination Date
_______________________________________________________
Last Working Day: ________________
Authorization Signature Date
Physical Plant (keys): _______________________________
VP Finance (Inventory):_______________________________
Office Manager (Cell Phone): _______________________________
Payroll (sick leave, vacation reports):_______________________________
Institutional Resources (Computer Access): _______________________________
Business Office (Fines): _______________________________
Benefits: _______________________________
Employing Department:_______________________________
Library ID: _______________________________
Retirement Program:
___Optional Retirement Program (ORP)
___I am requesting TSC to submit Termination/Vesting Letter to Carrier on file.
___I am requesting TSC NOT to submit Termination/Vesting letter to Carrier until I
notify the TSC District Office (in writing) to do so.
___Teacher Retirement System (TRS)
___I am requesting TSC to submit Request for Refunds to TRS. Request for Refund
form has been completed.
___I am NOTrequesting a Request for Refund from TRS.