HUMAN RESOURCES ACTION FORM
Separation or Termination from University
Employee’s
Last Day
Worked
Today’s Date
EMPLOYEE’S NAME:
Last Name First Name Middle Initial
Job Title
Department
REQUESTED
ACTION
Please Select
Resignation
NOTE: Another HR Action form
must be completed and
remitted to Budgets if
employee is moving from full-
time to part-time employment.
Retiring
Termination
(Transferring to
different Department)
NOTE: Another HR
Action form must be
completed and remitted
to Budgets for this
Action.
HR USE ONLY:
Transferred to Another USG Institution
EMPLOYMENT
STATUS
Please Select
Staff
Faculty
REQUIRED SIGNATURES
_______________________________________________________________
Department Head Dean
_______________________________________________________________
Vice President/Provost
_______________________________________________________________
Title III (if applicable) - Departments Must Route to Title III for Signature on
all Title III Positions Before Sending to Budgets
_______________________________________________________________
Budgets
_______________________________________________________________
Human Resources
HR Action Separation Termination Form.version.1
Forward to HR for Processing
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