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SUBMIT TO HR SUBMIT TO HR SUBMIT TO HR Please return this form to HR within 24 hours of an employee being terminated to ensure the terminated employee receives a paycheck during this pay cycle. Effective March 3, 2023 Department/Division: Job Title: Phone Number: Email Address: Final Check Stub Address for W-2 (If Different): (Note: All final checks and documentation will be mailed unless specified in “Other Comments” below) Reason for Separation: Resignation Termination End of Season WRS Retirement Other Last Day of Employment: (Supervisor: Ensure that time entry is done) Eligible for rehire: Yes No Other Comments: Employee Signature: Signature of Supervisor: SEPARATION CHECKLIST (Please mark off appropriate items for your department.) ITEM DATE INITIALS DEPT- Letter of Resignation forwarded to Payroll and HR DEPT- This form completed and forwarded to HR DEPT- Keys returned DEPT- Credit card returned DEPT- Uniform returned DEPT- Equipment returned DEPT- E-mail notification to I.T. and Facilities DEPT - E-mail notification to Fleet concerning fuel pin HR- COL ID Returned HR- Rec Center Membership Notification Instructions for 457 or Roth Change: FOR HR Received: Final Check Address Changed: W-2 Address Changed: FOR PAYROLL Form Received Date: Outstanding P/R Checks? Yes / No - If Yes, date of void & reissue Final Check Date Check Initials: Date: Admin Fee Yes No Flex Plan Yes No TERMINATED IN HTE: Date: HR Initials: TERMINATION FORM FOR ALL EMPLOYEES SIGN SIGN