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: |
Reason 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: ________________________________ |