W
Return of College Property
I understand that at the time of my separation as an active employee of the College of Wooster, I am responsible for the
return of College property that has been issued to me. This includes keys, electronic devices, charge cards, clothing and my
identification card. I understand that an unpaid charge account balance and the replacement cost of unreturned College
property will be deducted from my final paycheck and/or my accrued vacation payout.
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SIGNATURE DATE DEPARTMENT
Contact Information
NICKNAME__________________________________________ HOME PHONE________________________________________
CELL PHONE _________________________________________ PERSONAL EMAIL_____________________________________
DEPENDENT INFORMATION
THIS FORM IS TO ASSIST US IN IDENTIFYING DEPENDENTS FOR ID AND BENEFIT PURPOSES. PLEASE LIST BELOW
YOUR SPOUSE (IF APPLICABLE) AND ALL UNMARRIED CHILDREN UNDER 21 YEARS OF AGE.
FULL LEGAL NAME
GENDER
RELATIONSHIP
*DOES THIS DEPENDENT
RESIDE AT YOUR
ADDRESS
MALE
FEMALE
YES
NO
*IF DEPENDENT ADDRESS DIFFERS FROM YOUR CURRENT HOME ADDRESS, PLEASE INDICATE BELOW:
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