Fillable Termination Form (City)

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Termination Form (City)

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Country of origin: US
File type: PDF

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BROWSE CITY (AR) FORMS

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08/05 pe80
CITY OF LITTLE ROCK
COPY: Check One
Human Resources Personnel File
Human Resources Disciplinary File
Department
Division
Employee
NON-UNIFORM EMPLOYEE
DISCIPLINARY ACTION FORM
RECORD OF TERMINATION
DATE
EMPLOYEE #
DEPARTMENT
DIVISION
EFECTIVE DATE
Employee Name
Complete Home Mailing Address
This is to advise you that your employment with the City of Little Rock is hereby terminated for the following
reasons:
You have the right to appeal this action and may request an administrative hearing within ten (10) working days
upon receipt of this letter.
/ /
Employee’s Signature Date Immediate Supervisor’s Signature Date
(Does not necessarily imply agreement with
the stated reasons and/or disciplinary action.)
OR (if applicable)
/ /
1. Witness Date Division Manager’s Signature Date
/ /
2. Witness Date Department Director’s Signature Date
(indicates review and approval)
/
Union Steward’s Signature Date
(if applicable)
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Termination Form (City)

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Completed 18 July 2020

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