Separation Form
ADVERTISEMENT
1SEPARATION FORM
AT THE TIME OF SEPARATION, THE EMPLOYEE MUST BE PROVIDED WITH A
NOTICE TO EMPLOYEE AS TO CHANGE IN RELATIONSHIP AND EDD PAMPHLET DE 2320.
IF UNABLE TO PROVIDE ON THE LAST DAY WORKED, PAYROLL WILL PROVIDE ON THE RECEIPT OF THIS FORM.
Employee Name:____________________________________________ Red ID #: ________________________
Dept. Name: _______________________________________________ Date: ___________________________
Separation Date:______________ Labor Account(s) Affected: ________________________________________
Permanent Address (where W-2 will be sent):
Special Instructions for Final Paycheck (if applicable):
___________________________________________
____________________________________________
___________________________________________
____________________________________________
Reason for Separation
Voluntary
Involuntary (Must have Human Resources Approval)
Accepted a New Job
Reduction in Force (Permanent)
End of Internship / Temporary Assignment
Temporary Layoff - Subject to Recall ________
Graduation
Unable to Meet Job Requirements / Expectations
No Longer an SDSU Student
Dismissal for Cause
Relocation
Absenteeism / Tardiness
Other (specify) ________________________
Dishonesty / Theft
Falsification of Employment Records
_______________________________________
Insubordination
Intoxication (Alcohol / Drugs)
Refusal to Follow Instructions
Violated Established Company Policy
Other Misconduct (specify) ______________
_______________________________________
Final Evaluation (check one in each category)
ABILITY
Outstanding
Very Good
Acceptable
Unacceptable
ATTENDANCE
Outstanding
Very Good
Acceptable
Unacceptable
ATTITUDE
Outstanding
Very Good
Acceptable
Unacceptable
PRODUCTIVITY
Outstanding
Very Good
Acceptable
Unacceptable
Additional Comments: ________________________________________________________________________
__________________________________________________________________________________________
Eligible for re-hire?
YES
NO,
If NO, explanation and HR Director approval is required.
Explanation: ________________________________________________________________________________
__________________________________________________________________________________________
___________________________________________________________
_____________________________
HR Approval Signature
Date
A.S. property returned?
Yes
No
Notice to Employee as to Change in Relationship provided?
Yes
No
Approval Signatures
___________________________________________
___________________________________________
Supervisor
Date
Manager
Date
6/12
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business