NOTICE OF TERMINATION
Name:______________________________________________ |
SS Number:______( N A )____________ |
| Address:____________________________________________ City:_______________________________________________ State:______________________ Zip__________________ |
Full time _______ Part time ________ |
| Job Title:_______________________________________ | Grade:___________________________________ |
| Dept. Name_______________________________________ | Committee:______________________________ |
Start Date: _____________________________________ Reason for Termination: Resignation ___ Retirement ____Discharge:_____
Eligible for Rehire: YES____ NO____
|
Explanation for Termination:
|
| It is the
responsibility of the Citizen or Delegate to obtain Keys
and other property of the Government/People of the USA
from the terminated employee. Recorded and delivered by: ___________________________________________________________ Date: ________________________________ |