Term Form 8-2015
Hampshire College Notice of Termination Form - TERM
Name:__________________________________________________________________________________________________
Last First Middle
Forwarding Address (if applicable)_____________________________________________________________________________
Street City State Zip
Position Title: ___________________________________ Last Day Physically Worked: ___________ Term Date: __________
Classification: Exempt Non-Exempt Faculty Casual Other ________________________
FTE: Scheduled Hours: Employment Cycle (number of months):
Assignment Complete – ASC Involuntary/Performance – INP Position Eliminated/Involuntary – PEI
Violation of Policy – VIO
Yes No - Provide comments below
Comments:
(attach additional page if necessary)____________________________________________
Budget Manager/Supervisor Signature: Date: Close Vacated Position? Y N
Human Resources Office Processing
Employment Date: Date of Birth: Social Security Number:
Vacation (see below for calculation)
Calculation as of date: ______________
Hours due to employee: _____________
Hours owed to College: _____________
Plan: _____________
End Date
end of month in which employee terminates
End Date - is last day of employment
Conversion Notification
Annual Election: $_____________
End Date - is last day of employment
Medical Reimbursement Continuation
Yes No
(if yes, employee must sign continuation form)
End Date – last day of employment
Retirement Annuity
End Date -
is last day of employment
Supplemental Retirement
End Date - is last day of employment
end of month in which employee
end of month in which employee
Computer Club – Amount owed to College: $ _______________________(amount due is deducted from last paycheck)
Vacation Reconciliation Calculation
Current year – Number of mos. to be worked
Number of mos. Vacation earned
( # of mos. from July)
Vacation hours owed or to be paid
_____________________________ ________________________________ ________________________________
Payroll/Benefits Mgr./Date A.V.P. for Human Resources/Date Dir. of Strategic Budgeting & Analysis/Date
Human Resource Office Process Date/Initial: _______________ Pay Cycle: EP MP Close Vacated Position? YES NO
Instructions: Please complete form and send to Human Resources Office for processing, include employee’s letter of resignation
MISSING INFORMATION WILL DELAY PROCESSING. This document is confidential and should be treated accordingly.
Distribution by HR: HR/Personnel File Payroll
(HR) Jobcode to be closed: ______________________
