Student Worker Job Separation/termination Form
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1Student Worker Job Separation/Termination Form
Academic Year:
___________
______03 Worker
______04 Worker
Student Name:
CWID:
Student Job Title:
Supervisor:
Department:
Supervisor Phone Number:
Supervisor Email Address:
Last Date of Employment: ______________
Part I: Voluntary Separation
The student has decided to resign from the above position due to the following reason(s):
○
Position eliminated
Date: _______________
○
Student has never shown up for work
Date: _______________
○
Job Dissatisfaction (Attach Resignation Letter)
Date: _______________
○
Found New Campus Job (Attach Resignation Letter)
Date: _______________
○
Other: ________________________________
Date: _______________
Part II: Termination
The student has been terminated from the above position due to the following reason(s):
○
Poor Performance
Date: _______________
○
Behavioral Misconduct
Date: _______________
○
Poor Attendance
Date: _______________
○
Falsification of time worked reported on timesheet
Date: _______________
○
Violation of University Policies
Date: _______________
○
Other: ________________________________
Date: _______________
Discipline Procedures
In compliance with the termination policies set forth in the current Federal Work-Study and JLD Program Manual:
○
A Verbal Warning was given
Date: _______________
○
A Written Statement was issued (Attach Copy)
Date: _______________
○
Job Separation/Termination Form was completed
Date: _______________
○
Other: ________________________________
Date: _______________
Part III: Authorized Signatures
I/We certify that the terms of this separation/termination of employment have been discussed and the proper steps have been taken and
appropriate documentation is attached. Return a copy of this form to the Office of Financial Aid Services.
Employee's Signature:
Date:
Supervisor's Signature:
Date:
Rev. 8/2014
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Parent category: Business