Fillable Separation Clearance Form (Meredith College)

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Separation Clearance Form (Meredith College)

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The Separation Clearance Form (Meredith College) form is 1 page long and contains:

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Country of origin: US
File type: PDF

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Separation Clearance Form
__________________________________________________________________________________
All employees separating from employment with Meredith College are required to return all College
property and settle any accounts prior to release of final funds due to the employee. The College reserves
the right to offset any funds due the employee to compensate for unreturned or damaged property or
unsettled accounts. This document serves as verification for your personnel record that all equipment has
been returned and all accounts have been settled. Please make arrangements with your supervisor for time
during your work hours to obtain required clearance signatures prior to last day to be worked.
__________________________________________________________________________________
Employee Name: ______________________________________________ ID #: ________________
Department: __________________________________ Supervisor: __________________________
Last date to be worked: ________________ (Return this form to HR prior to or on last day to be worked.)
Check-out
Department
Clearance Item
Authorizing Signature
Do not sign until ALL items
are returned.
Date
Signed
Supervisor /
Employing
Department
All issued equipment returned (all keys,
uniforms, faculty voting clicker, department
cell phone, radio, pager, etc.).
Technology
Services
Discontinue access to systems and services
(cancel network access, e-mail access, security
codes, phone numbers, etc.); all equipment
returned (lap top, college cell phone, etc.)
Campus
Police
CamCard and parking decal returned. No
balance due for tickets.
Carlyle
Campbell
Library
All books and materials returned. No balance
due for fines.
Accounting
& Finance
All accounts paid (returned checks, unpaid
parking fines, etc.); credit card returned;
balance on CamCard to be refunded.
Human
Resources
Exit information for benefits / final payroll
provided. Exit interview offered.
Forwarding Address: Please give the address you would like your W-2 mailed to if different from address
on payroll files. Please contact us to update if this address changes before receiving W-2.
__________________________________________________________________
__________________________________________________________________
Phone:
___________
Employee Signature: ____________________________________________ Date: ______________
___________
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Instructions:
Supervisor is to notify HR as soon as they become aware employee will be separating.
Supervisor gives employee Separation Clearance Form or the employee may print from web site. The
employee is asked to visit all departments listed to verify accounts are settled and equipment is returned.
Signatures will be required from departments indicated.
Once completed, the employee presents the form to HR. The employee’s final payroll check may then be
released.
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Separation Clearance Form (Meredith College)

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Completed 23 August 2020

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