(To be completed by the employee’s direct Supervisor and submitted to HR for out
processing, along with the Personnel Action Form (PAF))
Department: Title:
1. __Completed __N/A
If resigning or retiring, have employee complete Voluntary Resignation Notice (Appendix E, Form 3). A
resignation letter may be substituted for the Voluntary Resignation Notice.
2. __Completed __N/A
Complete Change of Status Form to remove from payroll and obtain appropriate management signatures.
3. __Completed __N/A
Send the completed Voluntary Resignation Notice (or resignation letter and Change of Status Form) to Human
4. __Completed __N/A
Collect all City equipment from employee by the last day of work. Examples include:
__Procurement/Credit Card(s) __Cell Phone
__Laptop Computer
__Pager __Radio(s) __Key(s)
__Employee ID Card
__Tools __Weapons (return to HR)
5. If employee had a City Issued Credit Card, notify the Finance Department of employee’s separation.
Return all purchase cards/credit cards. Turn in final Purchase card and Expense statement with all
6. __Completed __N/A
If the employee used a City vehicle, notify Purchase Manager to disable city issued credit card.
7. __Completed __N/A
Notify IT of the termination date and if they need to:
Disable computer access
a. Class
b. Laserfiche
c. Email
d. Other:
If disabled/deleted email account, do emails need to be routed to someone else:
Do you need access to their H drive
Disable or delete voicemail
8. __Completed __N/A
Cancel Attendance in future training classes, seminars, or meetings as
9. __Completed __N/A
Remove employee’s name from Department routing lists.
10. __Completed __N/A
Completed by:
Supervisor Signature
Appendix E
Form 5
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