_______ _______
Motlow State Community College
P. O. Box 8500 – Lynchburg, TN 37352-8500 – 931-393-1542
Employee Out-Processing Checklist
Name
First Middle
System A#
Termination Reason:
Last
Last workday:
(Must agree with My Motlow time sheet)
Termination Date:
Position: Temp Regular FT/PT Adjunct
PROVIDE A FORWARDING ADDRESS:
Address:
Email Telephone
FINAL PAYMENT FOR SERVICES WILL NOT OCCUR UNTIL THIS FORM HAS BEEN EXECUTED AND RETURNED TO
THE ASST DIRECTOR, HUMAN RESOURCES AND IS DUE PRIOR TO DEPARTURE DATE (SEE EXCEPTION BELOW).
MAKE SURE TO INDICATE A FORWARDING ADDRESS TO RECEIVE FINAL PAYSTUB INFORMATION AND YOUR W2.
As a part of out-processing from MSCC, these departments MUST verified by the employee or supervisor,
and notification via an auto-email from HR reflecting your last workday will be issued where specified
below. This process assures that all supplies, equipment, records, and/or other materials, for which that
dept. is responsible and for which responsibility has been assigned to the employee, has been duly
accounted for and includes cancellation of access and special privileges as defined by MSCC policy. If
feasible, a terminating employee may arrange for their reporting dept. to assist with out-processing, and it
is the Supervisor's responsibility to assure each dept. is signed off. This form must reach the Assistant
Director, HR, Lisa Lee, prior to the employee’s departure date. Exception: Out-processing form for
terminating Adjunct faculty should be submitted by week two of the semester following the adjunct
faculty’s employment termination. NOTE: Non-Credit instructional staff must be out-processed by
INITIAL
DATE
supervisors and signed off after contact with the dept. is made.
1. Supervisor (President/VP/Dean/Director) as appropriate
_______ _______
2. Public Safety
HR auto-email sent _______
3. Library (Ext. 1665)
4. Technical Ops (Help Desk Ext. 1512) HR auto-email sent ________ _______ _______
Please note: Employee email acct will discontinue at the end of employment.
Administrative Computing (Ext. 1585)
(Database Administrator) HR auto-email sent ________ _______ _______
5. Business Office -Telephone Long Distance Access Code/FOMPROF terminated
Credit Card/P-Card turned in (Ext. 1930) HR auto-email sent ________ _______ _______
Payroll (Ingram Business Office Clerk) HR auto-email sent ________
6. Keys turned in (Facilities Services) _______ _______
7. Human Resources (Assistant Director, HR) (Tuition Benefit Check)
Benefits/Deductions Term/Continuation/Transfer
MSCC/State ID Card turned in (Ext. 1542)
_______ _______
