Termination Form

Termination Form

Leaders should use this form to report an employee separation and provide all relevant details. The information submitted will be used by Human Resources and designated internal stakeholders to facilitate the employee's offboarding process.
Employee Name:

First NameLast Name
Employee's Personal Cell Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Employee's Personal Email:
example@example.com
Job Title
Department
Is the employee independently licensed?
Is the employee a supervisor?
Please list the employee's direct reports and who will now be their new supervisor:
Termination/ CPR System Disconnection Date:

MonthDayYear
The termination and system disconnection date need to coincide.
Is the employee's last day worked (performed any work duties - emails, billing, etc.) the same as their termination date?
Last Day Employee Performed Work

MonthDayYear
Date
Employee termination is:
Reason for Employee Termination (Voluntary)
Reason for Employee Termination (Involuntary)
Other
Employer statement:
Can the employee be rehired?
The reason why he/she cannot be hired again:
Does the employee have any CPR IT equipment/property to return? (please list the equipment)
Does the employee have an admin building access and/or admin parking access card?
It is imperative you coordinate with IT and the departing employee an equipment drop off time. All appointments below are open for Equipment Drop-Off. Note: The calendar slot labels are for IT use only.
Please confirm Equipment Drop-Off date & time chosen above:
In the event the employee leaves the equipment with the manager, please reach out to IT and provide details.
Any related documents about termination (please upload resignation letter):

Cancelof
Supervisor Name:

First NameLast Name
Supervisor's CPR Email:
example@cprecovery.com
Supervisor Signature:
Date:

MonthDayYear
Date
Should be Empty: