City of Richmond
Employee Separation Checklist
Supervisor's Check List
Resignation Letter Received Date:
Notice of Separation Completed Date:
Employee Security Control Form Completed Date:
Password Revocation Form Completed Date:
Notice to Human Resources Benefit Section Date:
(e-mail to Marilyn Nother)
Agency Human Resources Manager notified Date: - - (Exit Interview)
Forms forwarded to Payroll Unit Date:
Notice to Stamet Coordinator completed and sent Date:
Completed by: Supervisor/Manager Date:
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Venassa Scott-Willams)
City of Richmond
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Emolovee Security Control Form
All City of Richmond orooertv must be returned uoon emolovee seoaration.
Employee Name: Soc. Sec. No.:
Division:
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City of Richmond Identification
Keys (Desk, Office, Building, Files, etc.)
Department Manuals/Books
Laptop computer
Cellular Telephones
Pager
Automobile
Uniforms
Work Tools/Equipment
Calculator -
Computer Equipment
Employee Departmental ill Badge
Other:
Other:
Other:
Forwarding Address:
Supervisor's Signature Date
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Attachment 3
75
CITY OF RICHMOND
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PASSWORD REVOCA nON NOTICE
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DATE:
TO: Systems Administrator
Technical Support Division
FROM:
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EMPLOYEE'S LAST NAME: FIRST NAME:
EFFECTIVE DATE: DIVISION:
The above named employee has temllnated services with the department. Please revoke
system access to all programs and Internet services.
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Signature:
Supervisor/Manager
Attachment 5
'11,
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