Employee Termination Form

Employee Termination

* = Required Information

Employee Name *

Term Date *

Site/Department where you primarily worked *

Last day person worked *

Reason for termination/infraction leading to termination (include date(s) of infraction) *

Was the employee aware that the infraction could result in termination, and if so, how? *

Explain why the infraction was significant and/or had a significant effect on the employer *

What other attempts were made to correct the performance concern (if applicable)?

Had the employee been counseled about this performance concern previously? *

Yes

Eligible for rehire *

Yes

Name/title of person completing this form *

Full Name *