Resignations & Releases - PART-TIME Employees

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Separation Information

Type of Separation*

Resignation Retirement End of Assignment Deceased Involuntary Termination/Dismissal for Cause

Last day at work*

Last day on payroll*

Is the last day at work the same date as the last day on payroll?*

Yes No

*** IMPORTANT TASK TO DO *** Remember to submit a time sheet to Payroll indicating how to charge days that fall between last day at work and last day on payroll.

Upload copy of separation letter, email, notification (if applicable)

No File Chosen

File uploads may not work on some mobile devices.

Personal Email Address (non-ECC email address)*

in case Payroll or HR need to make contact after the separation date

Mailing address to send future W2's to after separation*

Address Line 1

Address Line 2

City

State

ZIP Code

Division Review

Separation accepted by Division*

Yes No

Division's explanation for denying separation.*

Last day at work has not changed?

Yes No

Name of Reviewing Division Head/Dean*

Any additional notes (optional)

Area VP Review

Separation accepted by Area VP*

Yes No

Area VP's explanation for denying separation.*

Name of Reviewing Area VP*

Any additional notes (optional)

HR Director Review

Separation accepted by HR*

Yes No

HR Director's explanation for denying separation.*

Name of Reviewing HR Director*

Human Resources Review

REMINDER: Check if Division noted a change to last day. Wait 14 days from last day to term in HRS.

HRS Reason Code*

Name of HR Person updating HRS*

Is termination a PERS position?*

Yes No

*** IMPORTANT REMINDER *** Send MAR-1 Form to PERS employee.

Resignations & Releases for Part-Time Employees

Separation Information

Division Review

Area VP Review

HR Director Review

Human Resources Review