ID# Employee Name​ (Last Name, First Name, Middle Name) Client Assignment

Contact Number and Email Address

Date Assigned (mm/dd/yy) Date of Separation (mm/dd/yy) Position

Employment Status Reason for Separation

•​ Regular •​ ​Probationary ​•​Contractual ​•​Project-based •​ Resignation •​ ​ End of Contract •​ ​ Others: __________________

Instructions:
1. Please print legibly and complete all the information above.
2. To avoid delays in final salary payments, this form must be completed and submitted to HR on your last working day. You
must be C ​ LEARED​ by the relevant client departments that are indicated in this clearance form, if applicable.
3. All Timesheets during your tenure must be completed, submitted and approved by your approving authority on your last day
or prior to your separation.

DEPARTMENT / FUNCTION CLEARED BY: DATE

REMARKS
(Mark ​✔​ if cleared and/or X if not applicable) (Printed Name & Signature) SIGNED
PROJECT
Required Clearances:

• Pending Work, Files, Property were

transitioned to
____________________________ __________ ____________________
• Desktop PC; Username & Password
• VPN Secure Client User ID & Password
• Project Password
__________ ____________________
• Project Director User ID & Password _____________________________
• Project Printed Documentation Project Manager
• Company email was redirected to
____________________________ __________ ____________________
• Company drive was redirected to
____________________________
• Company Account Deletion Date:
____________________________

INFRASTRUCTURE
Required Clearances:

____________________
•​ Email & Password _____________________________
•​ Equipment, Service, Tools, Manuals Infrastructure Support
•​ Others _______________________

ASSETS AND FACILITIES

Required Clearances:
• Proximity Card
• Storage Keys
• VOIP
_____________________________
• Machine (PC/Laptop)
Assets
• Support Phone
• Headset
• Software License _____________________________
• Others _____________________ Facilities

_________________________________________
Signature over printed name

1 | ​Page PSI-I-F-HRD-002-v1.0
 Date: ​ __________________________

2 | ​Page PSI-I-F-HRD-002-v1.0