Employee separation record

Employee’s name (required)

Job title (required)

Department (required)

Employment type (required)

The separation

Last day worked (required)

Separation date, if different

For example when paid leave runs past the last day worked.

Type of separation (required)

Explain what happened

Facts and dates. Required for a dismissal.

Was notice given?

Resignation letter or supporting documents

For a dismissal, the disciplinary action forms that led to it.

Click or drop a file here

PDF, Word, images · up to 10 MB

Eligible for rehire? (required)

Final pay and benefits

For payroll.

Hours or leave to pay out

Unused leave, overtime or anything else owed.

Final paycheck date

When the last pay reaches the employee.

Benefits to end

Choose as many as you like

Equipment and access

Items to return

Choose as many as you like

Date to switch off system access

Sign-off

Completed by (name and role) (required)

Manager’s signature (required)

Draw your signature, or choose Type instead to type your name.