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Samara Company Termination Form
First and Last Name
Manager
Termination Date
*
required
Forwarding Address:
Reason for Seperation
*
Required
Job Abandonment
Insubordiation
Lack of Work
Tardiness
Unsatisfactory Preformance
Refusal to follow instruction
Job Eliminated or Changed
Voluntary With Out Notice or Reason
Got Another Job
Relocation
Illness
Scheduling Conflict
Enlisted in Armed Forces
Problem with Supervisor
Problem with Co-Worker
Personal Problem
Returned to School
Retired
Refused Sutiable Work
LOA- Did not return
Other
Explain the reason above in detail:
Is Employee Eligible for Rehire?
*
Yes
No
Items Received From Employee
*
Required
No Items to Recieve
Refused to Give Items
Keys
Laptop
Cell Phone
Credit Card
Uniform
Winter Gear if applicable
Other
Employee still needs to hand in items and has been reminded of deducions for misisng items.
Employee still needs to hand in items but was not reminded of deductions.
Have employees final hours been entred into Aspire?
Yes- With Signed Time Card
Yes- No Time Card
Still need to correct time with employee.
Unsure.
Other Notes:
Supervisor Signature:
Clear
Submit
Recieved. Thank You.
HR ONLY: Final Pay Check Date and Amount.:
HR Signature
Clear
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