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 NOT requesting a Request for Refund from TRS.