Employment Termination During Furlough Notice Form
Complete this form to document an employee's termination during furlough, including all relevant details for both parties.
Employee Full Name
*
First Name
Last Name
Employer/Company Name
*
Furlough Status
*
Currently on furlough
Scheduled to return from furlough
Other
Termination Effective Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Termination
*
Please Select
Position eliminated
Performance-related
Misconduct
Restructuring
Other
Last Working Day
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Final Paycheck Delivery Method
*
Direct deposit
Mailed check
Pick up in person
Benefits and Return of Company Property Status
*
All company property returned
Benefits discussed and explained
Outstanding items (please specify below)
Notice Delivery Method
*
In person
Email
Mail
I acknowledge receipt of this termination notice and understand the information provided.
*
I acknowledge
Submit Termination Notice
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