Revised 05/11/18
Las Positas College
Separation Checklist for Personnel Resignations and Retirements
The purpose of the Separation Checklist is to assist employees and their immediate supervisors when an
employee plans to resign or retire from the college. The form is to be initiated by the immediate supervisor
and completed in consultation with the departing employee at least two (2) weeks from the separation date
or last scheduled work day at the college, whichever occurs first.
Name of Employee: _____________________________ Identification Number: _______________________
Title: _________________________________________ Division: __________________________________
Mailing Address: ____________________________________________________________________________
Telephone Number: (________) ___________________ E-mail: _________________@_________________
Separation Date:* ______________________________
*Separation date means your last day working on-campus. Your last day of employment with the Chabot-Las Positas
Community College District may differ. Consult with your immediate supervisor to confirm appropriate separation date.
_____ Identification Card
Return your identification card to your immediate supervisor.
_____ Information Technology – Computer Hardware
All computer hardware (e.g., laptop computers, etc.) must be returned to the college. Attach the completed
“Request to Revoke Access to Administrative Systems” form to the Separation Checklist.
_____ Information Technology – Computer Software
Access to computer software (e.g., Banner, etc.) must be relinquished except for college issued electronic mail
accounts upon retirement and receipt of emeritus status by the Chabot-Las Positas Community College District.
Attach the “Request to Revoke Access to Administrative Systems” form to the Separation Checklist.
_____ Keys (including Building, Classroom, Mailbox, Office, Scanner, Security, and Vehicle)
Return all keys to the Las Positas College Office of Campus Safety and Security. Exceptions to this rule must be
made in writing and must be approved by your immediate supervisor and the appropriate vice president. Attach
the completed “LPC Request for Room Key(s)” form to the Separation Checklist.
_____ Parking Permit
Return parking permit to the Las Positas College Office of Campus Safety and Security except upon retirement
and receipt of emeritus status by the Chabot-Las Positas Community College District.
_____ Property
All college property (e.g., books, cabinets, equipment, files, keys, manuals, office supplies, tools, uniforms,
vehicles, etc.) must be returned to the appropriate issuing college entity or immediate supervisor.
Signature of Employee: ___________________________________ Date: ___________________________
Signature of Supervisor: __________________________________ Date: ___________________________
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