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Home
About Us
Employee Discounts
Contact Us
Resourceful Forms
Timekeeping
Home
About Us
Employee Discounts
Contact Us
Resourceful Forms
Timekeeping
Employee Separation Form
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Company Name
*
List the company in reference to this Separation
Separated Employee Name
*
First
Last
Separated Employee Position
Separated Employee Department
Date of Hire
Last day of employment
*
Separation Details
*
What were the factors leading to the separation?
Is separated employee eligible for rehire?
Yes
No
How many hours requested?
*
Upload Time Card
*
Click or drag a file to this area to upload.
Please upload time card card for our records
Any additional wages?
Yes
No
i.e. basic leave, PTO, vacation, etc.
How many hours?
*
Notes
breakdown of hours if needed (OT, DT, Sick)
Supervisor
*
First
Last
Date
*
Supervisor Signature
*
Clear Signature
Must be signed by supervisor
Submit
Mutual Arbitration Agreement
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I
*
First
Last
Date
*
Acknowledgement
*
I acknowledge that I have read and that I understand the Arbitration of Disputes policy. I further understand that the agreement to arbitrate may not be waived without a written document signed by both myself and the Company. If for any reason the Federal Arbitration Act (FAA) is deemed inapplicable to this Mutual Arbitration Policy, then and only then Arbitration will be governed by the California Arbitration Act, Code of Civil Procedure section 1280 et. seq. In such circumstances, I have the right to refuse to proceed to Arbitration. There will be no adverse consequences if I choose not to agree to Arbitrate any employment-related disputes as outlined above under the California Arbitration Act. If the Federal Arbitration Act (FAA) is deemed to be inapplicable and I still desire to proceed to Arbitration, If the Federal Arbitration Act (FAA) is deemed inapplicable, I AGREE to proceed to Arbitration
I acknowledge that I have read and that I understand the Arbitration of Disputes policy. I further understand that the agreement to arbitrate may not be waived without a written document signed by both myself and the Company. If for any reason the Federal Arbitration Act (FAA) is deemed inapplicable to this Mutual Arbitration Policy, then and only then Arbitration will be governed by the California Arbitration Act, Code of Civil Procedure section 1280 et. seq. In such circumstances, I have the right to refuse to proceed to Arbitration. There will be no adverse consequences if I choose not to agree to Arbitrate any employment-related disputes as outlined above under the California Arbitration Act. If the Federal Arbitration Act (FAA) is deemed to be inapplicable and I still desire to proceed to Arbitration, If the Federal Arbitration Act (FAA) is deemed inapplicable, I AGREE to proceed to Arbitration
Signature
*
Clear Signature
For mobile phones, and tablets use your finger to draw your signature.
Submit
CLOSE
