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Back to Forms for 'Firing & Termination'.




Employee Name: _______________________________


Date of Termination: _____________________________


Prior to separation from the company, collect the following items from the above employee:

[   ]   All keys returned.

[   ]   Company vehicle returned.

[   ]   Company credit cards returned.

[   ]   Company phone credit cards returned.

[   ]   Company equipment returned (e.g., portable phones, beepers, PCs).

[   ]   COBRA election forms signed and returned.

[   ]   401K election forms signed and returned.

[   ]   Profit sharing election forms signed and returned.

[   ]   Company documents and files inventoried.

[   ]   Desk and working premises inventoried.

[   ]   Personnel and Payroll Departments notified of departure.

[   ]   Final expense report received, reviewed and approved, expense check prepared.

[   ]   Final payroll check prepared (includes all accrued vacation pay, wages, sick pay, etc.)

[   ]   Exit interview prepared.

[   ]   Exit interview given.

[   ]   Final checks (payroll and expense) given to terminating employee.


All of the above duties have been completed in a satisfactory and timely manner.  Company has no further liability associated with terminating employee.


Manager's Signature: ____________________________            Date: _______________

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