HR Close Out Document

HR Close Out Document

Personal Information

Position Information

Employment Start Date:

Employment History (Most Recent)

From:   To:

From:   To:

Education

Graduation Date:

References

Company Property Return Checklist

Please check each item returned to the company and provide identifying details where requested.

Laptop / Serial No:

Charger / Power Adapter

Company Cell Phone / IMEI:

Building Badge / Access Card

Keys / Vehicle Keys

Hard-copy Company Documents / Confidential Materials

Other equipment (describe):

Access & Systems

Confirm revocation of access and list known usernames/accounts below.

Corporate Email Disabled

VPN / Remote Access Disabled

HR / Payroll System Access Removed

Code Repositories / Source Control Access Removed

Benefits, Final Pay & Expenses

Final payroll and benefit matters will be processed in accordance with company policy and applicable law. Complete the items below to facilitate processing.

PTO Payment to be processed

Confidentiality & Post-Employment Obligations

The employee acknowledges continuing obligations under any executed confidentiality, proprietary information, non-disclosure or restrictive covenant agreements. Employee affirms that all company confidential information and records have been returned and that no copies have been retained in any form other than where retention is authorized in writing by the company.

By checking the box below the employee certifies awareness that post-employment obligations remain in effect and that violations may result in legal action including injunctive relief and monetary damages.

I acknowledge and understand post-employment confidentiality and covenant obligations.

I acknowledge any applicable non-solicitation obligations.

Exit Interview

Forwarding Contact Information

Legal Disclosures & Certifications

At-Will Employment: The employee acknowledges that employment was at-will unless otherwise specified in a written agreement signed by an authorized representative of the company. Nothing in this document modifies that at-will status unless expressly set forth in a separate written agreement.

Equal Opportunity: The employee acknowledges the company's commitment to equal employment opportunity and non-discrimination.

Certification: I certify that all information provided in this close out document is true and complete to the best of my knowledge. I authorize the company to withhold from my final paychecks any amounts permissible by law to cover unreturned property or other valid obligations arising from my employment. I further authorize the company to contact prior employers and references as necessary to verify information.

By checking the box below the employee authorizes release of employment verification and relevant information to former employers, benefit administrators, and lawfully authorized representatives for the limited purpose of finalizing separation matters.

I authorize employment verification and related communications necessary to process this separation.

Acknowledgement & Authorization to Withhold

Employee acknowledges that failure to return company property or to satisfy financial obligations may result in offset from final wages to the extent permitted by law. Where offsets are not permitted, the company may pursue collection by other lawful means.

Employee also acknowledges receipt of company policy guidance regarding privacy, trade secrets, and proprietary information, and affirms that all company electronic access and devices have been surrendered or secured as required.

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