Employment Termination Form

• Prepared by

• Conducted on

  Date

• Employee Name

Personal Details

• First Name

• Last Name

• Job Classification

  Select Administrative Assistant Branch Manager Call Center Rep. Delivery Driver Maintenance Techniciann Office Manager Personnel Administrator Scheduling Coordinator Service Route Driver Shop Assistant

  • Administrative Assistant
  • Branch Manager
  • Call Center Rep.
  • Delivery Driver
  • Maintenance Techniciann
  • Office Manager
  • Personnel Administrator
  • Scheduling Coordinator
  • Service Route Driver
  • Shop Assistant

• Current Site

  Select

• Contact number

• Address

You are only required to fill out one of the following two sections, either 'Resignation Details' or 'Dismissal Details'.

Resignation Details

• Date notice was given

  Date

• Number of days' notice was given

• What is their last working day

  Date

• Did they work out their notice

  Yes

  No

  N/A

Deductions

• Please specify any last check deductions to be followed up by HR (health insurance, etc.)

Dismissal Deatils

• Was the employee given notice

  Yes

  No

  N/A

• If so, what date

  Date

• How much notice was given

• What is their last working day

  Date

• Reason for Dismissal

  Select Drugs/Alcohol Lack of Work Misconduct Poor Attendance Poor Work Performance Unsafe Work Practices Unsuited to Work Other

  • Drugs/Alcohol
  • Lack of Work
  • Misconduct
  • Poor Attendance
  • Poor Work Performance
  • Unsafe Work Practices
  • Unsuited to Work
  • Other

• Provide more details

• Provide Details for Dismissal

Performance Report - MUST BE COMPLETED

• Standard/Performance
  1 - Unacceptable
  2 - Lower than Expected
  3 - Meets Expectations
  4 - Higher than Expected
  5 - Excellent

• Safety

• Comments

• Attendance

• Comments

• Attitude

• Comments

• Ability to Perform Job Role

• Comments

• Flexibility

• Comments

• Productivity

• Comments

• Is this person suitable for re-employment in the future

  Yes

  No

  N/A

• Additional Comments

• Employee Signature

  Sign

• Branch Manager Signature

  Sign

Stored in Employment Personnel file

• Date and time of approval

  Date

• Approver's signature

  Sign