CIS-HOT Employee Termination Form

CIS-HOT Employee Termination Form
Employee Full Name*
Program/Position
FT/PT Status

Full TimePart Time
Termination Date*

MonthDayYear
Date
Reason for Termination
In addition to checking reason for termination, give a full explanation in space below. If the employee does not give notice of voluntary termination, note when and how it was determined he/she was terminated and give any other relevant information.
Voluntary

Without notice or reasonPersonal ReasonRelocationIllnessReturn to SchoolMarriageRetirementWorking ConditionsRefused Suitable WorkWork ScheduleLeave of Absence - Did not ReturnEnlisted in Armed ForcesPayEnd of Contract/ProgramAnother JobProblem with SupervisorProblem with Co-workerOther
Involuntary

AbsenteeismInsubordinationViolation of Rules/PoliciesLack of WorkIntoxicatedTardinessUnsatisfactory PerformanceRefusal to Follow InstructionJob Eliminated or ChangedInvoluntary RetirementOther
1. Explain reason given above in detail.
2. Employee's statement of reason for termination.
3. Is employee eligible for rehire?*

YesNo
If not eligible or only under certain conditions, explain:
Supervisor Full Name
Supervisor Signature
Today's Date

MonthDayYear
Date
Chief Officer Full Name
Chief Officer Signature
Date

MonthDayYear
Date
Chief Executive Officer Full Name
Chief Executive Officer Signature
Date

MonthDayYear
Date
Should be Empty:

Reason for Termination