Employee Termination Forms

EMPLOYEE TERMINATION FORM

Employee Information

Position Information

Termination Details

Effective Date:    Type: Voluntary Involuntary Layoff/Reduction in Force Other

Final Pay Date (anticipated):    Gross Final Pay Amount: $

Accrued Paid Time Off Paid Out: Yes No    Payout Amount: $

Severance Offered: Yes No    If yes, Severance Amount: $

Separation Checklist — Company Property & Access

The following items have been returned or revoked as indicated. If item not returned, note reason.

Company ID / Badge    Notes:

Keys    Notes:

Company Laptop    Asset Tag / Serial:

Company Phone    Phone Model / ID:

Confidential Documents / Files    Notes:

Corporate Credit Card    Card Number Last 4:

Systems Access Revoked    Systems:

Benefits and Continuation

Benefits End Date:    Continuation Options Provided: Yes No

Employment History (on file)

Employer #1

Employer #2

Education

References

Provide up to three professional references on file.

Legal Notices & Employer Statements

At-Will Employment: Employee acknowledges that employment was at-will unless otherwise set forth in a written agreement signed by an authorized representative of the employer. Nothing in this form modifies or terminates any previously executed written employment agreement, unless expressly stated herein and signed by both parties.

Equal Employment Opportunity: Employer maintains an equal opportunity policy. This termination is not based on any protected characteristic. Employee may contact Human Resources to request a written explanation of final pay computations or benefit continuation options.

Confidentiality and Trade Secrets: Employee remains bound by all confidentiality, nondisclosure, and proprietary information obligations contained in prior agreements or policies. Employee agrees not to disclose or use company confidential information after separation.

Employee Certification and Acknowledgements

I certify that the information provided on this form is accurate to the best of my knowledge. By signing below, I acknowledge receipt of this Termination Form, I acknowledge return of the items indicated above (unless otherwise noted), and I understand my obligations regarding confidentiality and company property. I understand that I may be required to execute additional separation documents, including any applicable release of claims in exchange for severance, if offered.

Employer Certification

The undersigned employer representative certifies that the information recorded on this form is accurate, that final wage calculations comply with applicable wage payment laws, and that company policies regarding separation and property return have been followed. Employer will provide any statutorily required notices and documentation concerning benefit continuation and final compensation.

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