Fillable Exit Form REVISED Feb 2018- Fillable (Lurleen B Wallace Community College)

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Exit Form REVISED Feb 2018- Fillable (Lurleen B Wallace Community College)

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BROWSE LURLEEN B WALLACE COMMUNITY COLLEGE FORMS

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Section 2: To be completed by the employee.
Section 3: To be completed by Human Resources.
SIGNED: ______________________________________ _________________________________
Employee Date
______________________________________________ _______________________________________
Supervisor Date
______________________________________________ _______________________________________
I.T. Office Date
______________________________________________ _______________________________________
Human Resources Coordinator Date
______________________________________________ _______________________________________
President Date
cc: Human Resources Office President’s Office
I.T. Office Supervisor
Payroll Office Revised Date: February 6, 2018
EXIT EMPLOYMENT FORM
Section 1: To be completed by the immediate supervisor.
EMPLOYEE’S NAME: ___________________________________________ ID #: __________________________
Job Title: _____________________________________________________________________________________
Date Hired: _____/_____/______ Last Day Worked: _____/_____/______ Pay Through: _____/_____/______
Type of Termination: Retirement 󠆦 Resignation 󠆦 Dismissal 󠆦
Recommended for Rehire: Yes 󠆦 No 󠆦
SUPERVISOR’S REPORT: _____________________________________________________________________________
_____________________________________________________________________________________________________
Equipment or Other College Property Returned:
Key(s)? 󠆦 Grade Books? 󠆦 I.T. Equipment? 󠆦 Other? 󠆦 _______________________________________
EMPLOYEE’S REPORT: ______________________________________________________________________________
____________________________________________________________________________________________________
Provide a personal, non-LBWCC e-mail address which will be required for the mandated electronic delivery of the
Compensation and Benefits Statement, in compliance with the Truth in Salary Act No. 2015-82.
_____________________________________________________________________________________________________
Provide user names and passwords for all LBWCC accounts and devices: __________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
H.R. OFFICE REPORT: _______________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
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Exit Form REVISED Feb 2018- Fillable (Lurleen B Wallace Community College)

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Completed 2 February 2021

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