Employee Termination Notice "*" indicates required fields Client Name* Employee Name* First Last Employee Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Last 4 Digits of SSN*Date of Hire* MM slash DD slash YYYY Date of Termination* MM slash DD slash YYYY Last Day Worked* MM slash DD slash YYYY VoluntaryVoluntary To accept other work Medical / Maternity leave Relocating to another area Personal / Family responsibilities To attend school Military service Failure to return from leave of absence Job transfer refusal Job dissatisfaction Retirement Voluntary Disability Compulsory Compulsory: InvoluntaryInvoluntary Repeated insubordination Repeated tardiness / absenteeism Falsified information on application Repeated violation of safety rules Repeated violation of company rules Dishonesty / Theft Failed to maintain union status Substandard performance Destruction of company property Probation period (within 90 day) Violation of Drug Free Work Place Program Layoff Lack of work Reduction in force Job position eliminated Reduced hours Temporary seasonal OtherOtherEmployee Signature By typing your name on any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing.Date MM slash DD slash YYYY Supervisor Signature By typing your name on any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing.Date MM slash DD slash YYYY Human Resources Signature By typing your name on any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing.Date MM slash DD slash YYYY Δ
