Departure Form

Departure Form
Important Note to the Departing Staff/Faculty Member
Before the last day of work, please take the following steps:
Complete the Departure Form on page 2 of this document and give to your supervisor/
department chair.
Record your forwarding address in Cascade under "Your Employment Information" so that you
receive your W-2 form.
Return your picture identification card to your supervisor/department chair.
Return borrowed books or other library materials (i.e. periodicals, film, audiovisual equipment) to
Collins Library.
Return university keys and key cards to your supervisor/department chair or hand-deliver to
Security Services.
Return university P-cards to Accounting & Budget Services, complete and submit approved
expense reimbursement requests, prepare receipts for submission, and note approvals in the Pcard system.
Transfer any institutional memberships and subscriptions that are in your name.
Clean out lockers reserved in the Fieldhouse or in Warner Gym and turn in university locks, towels,
and your facilities use card to the Athletics Department.
Contact the Student Accounts Office to make payment arrangements if you and/or other members
of your family are registered for classes and receiving tuition remission, Tuition Exchange (TE) or
Northwest Independent College tuition exchange (NIC).
Staff Only: Contact Human Resources at extension 3369 or [email protected] to schedule your
exit interview.
On your last day of work, please take the following steps:
Staff Only: Update and approve your final time worked report and/or leave in Kronos.
Through your department head/chair, arrange for the transfer of your electronic files to the
designated individual authorized to access the files.
Remove your personal property from your locker, desk, and/or workspace.
Return university property (i.e. uniforms, tools, supplies, equipment, computers, and software) to
your supervisor/department chair .
Remove your university parking decal from your vehicle and turn it in to Security Services.
Complete and submit the forms you receive from Human Resources if you are eligible for COBRA
(within 60 days of your last day of work).
Employment Departure Form
Job Title:
Final check:
Pick up in Payroll
Mail to Home Address
Intended Departure Date:
Zip Code
Record your reason(s) for leaving in order of importance (select from drop-down boxes):
Reason for Leaving #1
Reason for Leaving #2
Reason for Leaving #3
Faculty/Staff Member Signature: ____________________________________
Date: __________________
Supervisor Signature: _____________________________________________
Date: __________________
Department Head/Chair Signature: __________________________________
Date: __________________
Instructions to Department Head/Chair: send signed form to HR, CMB 1064.
For Human Resources Use Only
Layoff [31]
Left Without Notice [30]
Deceased [32]
Contract Expiration [34]
Returning to School [35]
End of Temp Assignment [36]
Form Updated 04/29/2011
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