Termination Form & Termination Letter

EMPLOYEE INFORMATION
Employee Name: Employee ID:

Employment Status: ☐Full Time ☐Part-Time ☐Contractual

Complete Address:

City: State: ZIP Code:

Contact Number: Email ID:

EMPLOYEE TERMINATION FORM

Termination Type: (Check One) ☐Voluntary ☐Involuntary

Supervisor’s Name: Click here to enter response.
Termination Effective From: Click or tap to enter a date.
Number of hours usually worked: Per day _____ Hours Per Week _____ Hours
Employment Duration in the Company: ______ Months
Employed From Click or tap to enter a date. To Click or tap to enter a date.
Reason for Termination/Separation:
☒ Low Attendance/Failed to report to work for ___ consecutive days.
☐ Indefinite Layoffs
☐ Employee Quit with verbal/written notice.
☐ Contract Expiration
☐ Employee dismissed because (Reason): Click here to enter response.
☐ Other (Explain): Click here to enter response.

Employee Evaluation
(Tick Appropriate Column)
Unsatisfactory Fair Satisfactory Good Excellent

Attendance
Work Quality

Competencies
Job Knowledge

Initiatives
Rehire Considerations: ☐ Would Not Recommend ☐ Recommend Consideration

Notice Period ☐Yes ☐No If Yes, Number of Days: _____

Severance Pay: ☐Yes ☐No If Yes, Amount: ____________

Other Comments: Click here to enter response.

Authorized Signature: Date:

__________________ Click or tap to enter a date.