Employee IT Outprocessing Form

EMPLOYEE IT OUTPROCESSING FORM

Personal Information

Position Information

Reporting Manager:

Last Day of Employment:

Employment History

Employer 1

Employer 2

Education

Graduation Date:

References

Reference 1

Reference 2

Reference 3

IT Outprocessing Checklist — Assets & Returns

All equipment must be returned in working order unless otherwise noted. Indicate returned items and provide identifying information where requested.

Laptop returned (make/model/serial):

Power adapter / charger returned (serial if applicable):

Mobile device returned (make/model/imei):

Security/access badge returned — Badge ID:

Physical keys returned — Describe:

Access, Accounts & Software

Confirm revocation or transfer of all accounts and entitlements. Check each item when completed and include account identifiers.

Corporate email account (username):

VPN / Remote access revoked (account):

Admin / privileged accounts revoked — List accounts:

Cloud service accounts terminated or transferred — Service names:

Data Handling & Backup

Personal data removed from company devices (employee attests)

Corporate data transferred to manager/archived — Location or custodian:

Backups verified and retained per retention policy

Security, Passwords & MFA

MFA tokens reset / removed from devices

Shared or group passwords changed where required

Legal Disclosures & Acknowledgements

At-Will Employment: I acknowledge that employment with the company is at-will unless otherwise provided in a written agreement signed by an authorized company representative.

Equal Opportunity: The company complies with equal employment opportunity laws and will not tolerate discrimination or harassment.

Confidentiality and Return of Property: I certify that all company confidential information, trade secrets, documents, and electronic files in my possession have been returned or transferred and that I will not retain copies. I understand the company may take lawful action to protect its confidential information.

Withholding: I understand that failure to return company property may subject me to financial liability and that the company may, to the extent permitted by law, withhold amounts from final compensation to cover unreturned property.

Authorization: I authorize the company to contact prior employers and third parties to verify performance, conduct background and security checks related to my offboarding, and to take necessary steps to remove my access to company systems.

Employee Certification

I certify under penalty of perjury that the information provided on this form is true and complete to the best of my knowledge. I acknowledge that I remain bound by post-employment obligations contained in any confidentiality, non-disclosure, non-solicitation, or proprietary information agreement I have executed with the company.

I further acknowledge that company systems and accounts to which I had access are the property of the company and that I will not attempt to access them after my termination date.

IT Department Certification

IT representative certifies that the assets listed above have been inspected, returned, or otherwise accounted for; that access to company systems, platforms, and administrative accounts has been revoked or reassigned; and that notes on any outstanding issues are entered below.

IT confirms access revocation and asset disposition as recorded above.

Authorization to Contact Previous Employers

By signing below I authorize the company to contact the employers listed in the Employment History section for verification purposes related to my employment and offboarding. This authorization remains valid for a reasonable period necessary to complete final clearance and recordkeeping.

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