STUDENT EMPLOYMENT PROGRAM
EMPLOYEE SEPARATION SLIP
Last Name, First Name MI
Student Employee Position Title
Student ID #
Immediate Supervisor
EARNINGS TO DATE REASON FOR SEPARATION
$ Amount Ending Date _________________________________
Earnings as of last payroll period ____________ ____________ __________________________________
Earnings since last payroll period ______________ _____________ ______________________________________
___________ X ________________ ______________________________ ______________________________________
# HRS $11.00 Last Day Worked
Supervisor’s Signature Date