Rev 28Apr2021
Employee Responsibilities:
☐Return library books and settle outstanding fines.
☐Contact Parking Services and settle outstanding permit fees or fines. Contact the Technology Product
Center (computer store) and settle outstanding payment plans.
☐Employee Self-Service (i.e. pay advices and current and past W-2s) will be available after the end of
employment. Refer to: http://my.ucf.edu
.
☐Complete Employee Exit Questionnaire and forward to Human Resources,
http://hr.ucf.edu/files/EmployeeExitQuestionnaire.pdf
.
☐If desired, request an exit interview with department head or designee.
☐Consent to electronic W-2 through Employee Self Service. You can verify your access to your W-2 by
signing into http://my.ucf.edu
. After logging in, click Employee Self Service, Payroll and Compensation,
W-2/W-2c Forms. Ensure a valid personal email address is listed for W-2 notification.
☐Leave Transfer-contact payroll@ucf.edu to indicate a desire to transfer leave balances to an accepting
employer prior to the termination date. The future employer should send an official note requesting leave
balance information directly to Human Resources within 2 weeks of the termination date.
☐Leave Payout Deferral – If interested in deferring any part of the leave payout to a voluntary retirement
plan 403(b) Plan or 457 Deferred Compensation Plan, contact benefits@ucf.edu
to request and complete a
Leave Payout Deferral Form upon termination.
☐Review the Employee Offboarding Guide, https://hr.ucf.edu/files/UCF-Employee-Offboarding-
Guide.pdf.
Employee Signature: _____________________________________________ Date: ________
Print
ed Name: __________________________________________________
(Note: If employee is not available for signature, complete the checklist to show that the department has
thought through the termination process and write “signature not available” in the space above.)
General Information:
If desired, an appointment may be made with a Benefits Section team member (Benefits@ucf.edu or 407-823-2771) for the
following:
☐Obtain information regarding insurance coverage/COBRA benefits. Employees that are enrolled in health,
dental or vision insurance at the time of termination are eligible for COBRA
coverage. Since premiums are
paid a month in advance, the employee may still have coverage through the month following termination.
Once the termination is completed in PeopleSoft and sent toPeople First, COBRA information will be sent to
the home address the employee has on file with the University. To obtain COBRA coverage, the employee
must complete the appropriate paperwork and return it to People First within the specified time frame.
☐Obtain information regarding retirement accounts including FRS Pension Plan, FRS Investment Plan, State
University System Optional Retirement Program (ORP) and voluntary retirement savings plans (403B and
457),
☐Special Pay Plan: Leave Balances for employees who are 55 years and older and who will receive a leave
payout of $10,000 or greater will be deferred to a 401(a)-account administered by TIAA. Additional
information is available on the HR website at:
https://hr.ucf.edu/files/SPP401a.pdf.
☐Conversion policies maybe available for certain supplemental plans through the State of Florida Group
Insurance Program and The Gabor Agency.
Keep checklist in department files for at least three fiscal years; do not send to Human Resources.
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signature
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