TERMINATION CHECK-OUT FORM

Name of Employee:
Department:
Date of Termination:

 

(Employee should return completed form to Human Resource Services prior to receiving final paycheck.)

DEPARTMENT MATERIALS: CHECK WITH INITIALS DATE Keys: Office Supervisor     Uniforms Supervisor     Equipment/Tools Supervisor     FINANCIAL SERVICES:       Accounts Receivable Financial Services     Employee/Computer Loan Financial Services     Insurance Premium Financial Services     OTHER DEPARTMENTS:       BYUH Housing Housing Office     Security Housing Office     Mail Box Post Office     Books/Materials LAS     Health Center Health Center     Purchasing Card/Cell Phone/PDA Purchasing     American Express Card Travel Services     HUMAN RESOURCES:       BYUH I.D. Card Human Resources     PCC Discount Card Human Resources     Insurance Card Human Resources

Forwarding Address/Phone:  

I have cleared all encumbrances, returned University property and pail all obligations to my knowledge.

Date		Employee Signature

cc:	MIS
	ITS
	Purchasing