Employee Termination Form Sample

Rev. 1.1 Updated 05/2014

Company Name: Date:

Employee Name: Social Security #:

Termination Date: Last Date Worked:

Reason for Termination:

Voluntary Involuntary

Resigned with Notice No Call, No Show Poor Performance

Moved Labor Dispute Laid Off

Retired Job Abandonment Violation of Policy

Resigned without Notice Relocated E-Verify Involuntary

Personal E-Verify Voluntary Transfer Company

Documented Disciplinary Action Prior to Termination (please provide copies):

Verbal Warning(s) Written Warnings None

Explanation (required):

Copy to: Employee Employee File National PEO Other:

Employee Benefits Health Dental Vision 401(k) Other:

Employee Acknowledgement:

My signature indicated that this notice has been discussed with me and that I understand its contents.

Employee Signature: Date:

Supervisor Name: Title:

Employee Termination Form

Please fill out and return to your Payroll Specialist

Fillable Printable Employee Termination Form Sample