Separation Form
Employee Name
First Name
Last Name
Employee Number:
Department:
*
Position:
*
Date of Hire:
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Separation Effective Date:
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Last Date Worked:
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shift:
*
1st
2nd
3rd
Employment Type:
*
Full Time
Part Time
Seasonal
Temporary - Manpower
REASON FOR TERMINATION-SEPARATION
Involuntary:
Attendance
Layoff
Performance
Company Violation/Misconduct
Misconduct
N/A
Other
Voluntary:
Another Job
Attend School
Medical
Retired
Disliked Job
Moving
Personal
Other
Comments:
*
APPROVALS
Manager/Supervisor Name
First Name
Last Name
Approved?
Yes
No
Signature
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
1
HR Manager Name
First Name
Last Name
Approved?
Yes
No
Signature
Date:
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
2
HR SEPARATION TASK CHECKLIST
HR Form Processor Name
First Name
Last Name
Employee
First Name
Last Name
SALARIED EMPLOYEE
Rows
Complete
N/A
Uniforms, if applicable
Keys
Credit Card(s)
Laptop
Forward Email & VM if applicable
Courtesy email to office personnel regarding term
Email IT of termination (network access, phone, email)
Transition agreement (if applicable)
ALL EMPLOYEES
Rows
Complete
N/A
Email Supervisor - Return onboarding binder if in locker or desk
Machine Operators - Call & email EE to return their uniforms
Terminate employee in ADP
Terminate employee in Navigator (if applicable)
Terminate in Fastenal Vending
Disable in KPA Training
Notify Aramark to cancel uniforms, if applicable
Collect the I-9 form to their personal file
Submit
Should be Empty: