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Employee Termination Form
Step
1
of
4
25%
Employee Full Name
*
First
Last
Company
*
Employee Social Security Number
*
Employee Job Title/Department
*
Last Date Worked
*
MM slash DD slash YYYY
Date of Last Check
*
MM slash DD slash YYYY
Will the last check be part of the normal payroll cycle?
*
Yes
No
Reason for Termination
*
No Call/No Show/Job Abandonment
Reduction in Workforce
Terminated for Cause
Resigned with Notice
Resigned without Notice
Temporary Layoff
Other
Further Explanation of Termination (if needed)
You can also attach additional information below
File
Drop files here or
Select files
Max. file size: 2 GB.
Pursuant to Texas Senate Bill 51, failure to send this form to Integrity in a timely manner may result in Client being charged for uncollected premium.
Person Submitting Form
*
First
Last
Date of Submission
*
MM slash DD slash YYYY
Δ
If you need to fill out an Employee Labor Release & Separation Form please click below:
Click Here
