Please complete this form to begin the administrative process when terminating an employee. Provide as much information as possible. Our payroll team will reach out, if there are additional questions. If you have immediate concerns, please email firstname.lastname@example.org.
Company name *
Last date worked *
Company representitve completing this form (Name and title) *
Employee name *
Employee state of residence *
Employee worked in state *
Pay employee through (if different than last date worked) *
Is there a severance being offered? *
Explain the details of the severance (lump sum, salary continuation)
Is the severance continguent upon the employee signing a release?
What date does the offer expire?
Any other compensation being paid at termination? (commissions, reimbursements) *
Describe the amount to be paid to employee
Did the employee have company sponsored medical benefits? *
What date will the benefits terminate?
Does the employee have unused PTO to be paid out? *
Number of unused hours to be paid
You have completed the employee termination process. Our team will contact you, if there are any additional questions.
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