Termination Form

Termination Form
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@example.com
Supervisor Signature:

Clear
Date:

MonthDayYear
Date
Should be Empty: