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
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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:
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