Termination Form

Name

First Name

Last Name

Department

Position

Effective Date

MM

DD

YYYY

Termination was:

Requestor's Name

Requestor's Email

Requestor's Phone Number

Department Head/ Supervisor

What phone number was this employee using?

Do you want to keep undeleted voicemails for this person?

Did the employee have county email on a mobile device?

Please list any additional termination instructions: