HR - Notice of Departure

This form is to be submitted to the Office of Human Resources for notification of the end of employment for faculty and staff as soon as the department is aware of the employee’s departure. A Staff/Faculty Departure checklist must also be completed. *If just ending a single position, but not ALL, use a Change of Information form instead.

1Employee > 2Retiree > 3HR/Payroll > 4Review Your Entry
Employee Information
Employee Name Employee Name First Last
Colleague ID#
Must be 7 characters. Currently Entered: 0 characters.
Is the employee an alumnus and/or retiree?

Is the employee an alumnus and/or retiree? Yes No
Employee email
Email of person submitting this form:
If applicable, do you know the new address of the employee?

If applicable, do you know the new address of the employee? Yes No N/A
New Address New Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
End of Employment Information
Department
Last Day Worked Last Day Worked / MM / DD YYYY

Last day employee working (exclusive of vacation, etc.)
Was exit interview held?

Was exit interview held? Yes No
Reason for End of Employment

Reason for End of Employment Termination Resignation Early Retirement* Regular Retirement** Deceased Reduction in Workforce End of Assignment *(To be used for Temporary positions ONLY)*

*Early Retirement Eligibility is defined by faculty handbook
**Retirement eligibility is 60+ years of age & 10+ years of service, or 25 years of service if under age 60
Please upload a copy of the resignation letter.

Attach Files
Does another employee need access to this person's email or files for business continuity purposes?

Does another employee need access to this person's email or files for business continuity purposes? Yes No

This access is subject to approval by Human Resources and the Department Technology decision maker
Is the employee eligible for rehire?

Is the employee eligible for rehire? Yes No
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Enter Your Email Address *

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HR - Notice of Departure

HR - Notice of Departure

Employee Information

End of Employment Information