_______________________________________ ________________________________________
_______________________________________________ __________________________
_______________________________________________ __________________________
Pasadena Area City College District
Office of Human Resources
REQUEST FOR TERMINATION OF ASSIGNMENT
Employee (Last Name, First) Employee ID #
Contact Person_____________________________Ext.___________ Department________________________________
TERMINATION OF ASSIGNMENT(s)
College Assistant, Professional Expert, Intern,
Apprentice, Short-Term substitute Effective Date of Termination
___________ 2312 ______________ ________________ __________________________
___________ 2312 ______________ ________________ __________________________
Student Worker Effective Date of Termination
___________ 2311 ______________ ________________ __________________________
___________ 2311 ______________ ________________ __________________________
Instructional Aide Effective Date of Termination
___________ 2410 ______________ ________________ ___________________________
___________ 2410 ______________ ________________ ___________________________
TERMINATION OF A VOLUNTEER ASSIGNMENT
Department Effective Date of Termination
TERMINATION OF A PERSONAL SERVICE ATTENDANT ASSIGNMENT
Department Effective Date of Termination
Cost Center Manager’s Name __________________________ Signature _____________________ Date _______________
Request for Termination of Assignment – June 2017
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