Payroll Final Pay Processing

PAYROLL FINAL PAY PROCESSING

Personal Information

Position & Termination Details

Reporting Manager:   Last Day Worked (MM/DD/YYYY):

Termination Type: Resignation Termination Reduction in Force Other   If Other, specify:

Final Pay Items (check all that apply)

Regular wages due    Unpaid overtime    Accrued unused vacation/PTO

Sick leave payout    Bonus/Commission    Severance

Expense reimbursement    Other adjustments   If Other, explain below:

Itemized Final Pay Calculation

Deductions & Adjustments

Pay Distribution

Method of final payment: Direct deposit Paper check Pay card

Date of final payment issuance (MM/DD/YYYY):   If payment delayed, reason:

Benefits & Post-Employment Notices

Benefits termination date (MM/DD/YYYY):

COBRA/continuation notice provided: Yes No

Approvals and Processing Checklist

Manager review completed:   Manager printed name:

HR review completed:   HR representative:

Payroll processing completed:   Payroll processor:

Employment History

Previous Employer 1 — Company Name:   Title:

Dates Employed:   Reason for Leaving:

Previous Employer 2 — Company Name:   Title:

Dates Employed:   Reason for Leaving:

Education

References

Reference 1 — Name:   Phone:   Email:

Relationship:

Reference 2 — Name:   Phone:   Email:

Relationship:

Reference 3 — Name:   Phone:   Email:

Relationship:

Legal Disclosures & Certifications

At-Will Employment: Employee acknowledges that employment relationship was at-will and may be terminated by either party at any time, with or without cause, unless a separate written agreement provides otherwise.

Equal Opportunity: Employer maintains a policy of equal employment opportunity and prohibits discrimination on the basis of protected characteristics in accordance with applicable law.

Authorization for Deductions: Employee authorizes lawful deductions from final pay including but not limited to taxes, benefits premiums, loan repayments and property deductions as set forth above. Any deduction not expressly authorized by law will not be taken without separate written consent.

Authorization to Verify: Employee authorizes Employer to verify prior employment, education, and to perform such employment-related checks as necessary for record keeping and final payroll reconciliation.

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