Employment Background Check Termination Notice
Complete this form to document and notify relevant parties regarding an employee's termination and background check process.
Employee Full Name
*
First Name
Last Name
Employee ID Number
*
Position/Job Title
*
Department
*
Supervisor/Manager Name
*
First Name
Last Name
Termination Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Termination
*
Performance Issues
Misconduct
Redundancy/Layoff
Attendance Issues
Resignation
Other
Was a background check completed for this employee?
*
Yes
No
If yes, please indicate the background check findings or any relevant notes.
Contact Information for Follow-Up (Phone or Email)
*
Additional Comments or Notes (optional)
Signature of Supervisor/HR Representative
*
Submit Termination Notice
Submit Termination Notice
Should be Empty: