ࡱ>  SbjbjVV |<< FFDYB .EL\p!$J]eeee ep|>ao 0B \$\$\$0F"hB eeee\$F O:  EMPLOYMENT TERMINATION FORMOffice of Human Resources Southern Illinois University Edwardsville ADMINISTRATIVE & PROFESSIONAL STAFF  CIVIL SERVICE  FACULTY  GRADUATE ASSISTANT (To be completed by the employee and employing department.)  Name: FORMTEXT      Social Security No.: FORMTEXT      Banner ID: FORMTEXT      Employee s Email:  FORMTEXT       Supervisor s Name: FORMTEXT      Supervisor s Email: FORMTEXT      Effective Date: FORMTEXT      Time: FORMTEXT       FORMCHECKBOX  c.o.b.  FORMCHECKBOX  a.m.  FORMCHECKBOX  p.m.Number of hours to be paid for final day of employment:full day  FORMCHECKBOX  or no. of hours: FORMTEXT     FORWARDING ADDRESS: Keeping your address current is necessary in order to receive your W-2's at the end of this tax year. Please contact the Office of Human Resources with any address changes you may have until you receive your final W-2's for this tax year. FORMTEXT       FORMTEXT       FORMTEXT       PRESENT POSITION:  FORMCHECKBOX  Administrative & Professional Staff  FORMCHECKBOX  Civil Service  FORMCHECKBOX  Faculty  FORMCHECKBOX  Graduate Assistant Rank/Title: FORMTEXT      Hire Date: FORMTEXT      Current Semi Monthly Salary or Hourly Rate: FORMTEXT      Rank/Title: FORMTEXT      Hire Date: FORMTEXT      Current Semi Monthly Salary or Hourly Rate: FORMTEXT      School, College, or Unit:  !"(efgɺ؟u_uIuu+jW h;h;5CJOJQJU\^J+jOh;h;5CJOJQJU\^Jhd 5CJOJQJ\^Jh:+5CJOJQJ\^JhCJOJQJ^Jh6CJOJQJ]^JhCJOJQJ^Jh5CJOJQJ\^JhV5CJOJQJ\^Jhh5OJQJ\^J hCJjh;h;CJUh:+ !"<fUkde$$IfTl40 ~*`  *44 laf4T $$Ifa$gd $Ifgdfgh   $IfgdV $$Ifa$gd $IfgdgdUkd$$IfTl40 ~* `  *44 laf4T       ! " ( ) 3 4 ζΪqaNa8a*jhhCJOJQJU^JmHnHu%jh;CJOJQJU^Jjh;CJOJQJU^J%hh5B* CJOJQJ\^Jph%h5B* CJOJQJ\^Jphhh5CJOJQJ\^Jh:+CJOJQJ^JhhCJOJQJ^Jh6CJOJQJ^JhCJOJQJ^Jh5CJOJQJ\^J+j_ h;h;5CJOJQJU\^J ! 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SUBMITTED BY:DATE:Employee's SignaturePlease sign and make a file copy before forwarding. The Office of Human Resources WILL NOT be sending copies of this document. >> SIGN WITH BLUE INK << >> SIGN WITH BLUE INK << >> SIGN WITH BLUE INK <<ACCEPTED BY:Director, Human ResourcesDateDean/Director/Chair/Fiscal OfficerDateVice ChancellorDate PLEASE ATTACH EMPLOYEE VACATION/SICK LEAVE REPORTING FORM TO THIS DOCUMENT (Rev. 8-22-11) HHH H"H$H2H4HHHJHLHVHXHZHbH~HHHHHHHHHHHHHHܺܺܺnܺ[ܺnܺ%j=6h;CJOJQJU^J%hLaS5B* CJOJQJ\^Jph%hd 5B* CJOJQJ\^Jph%j4h;CJOJQJU^J%h 25B* CJOJQJ\^Jphh 2CJOJQJ^J*jh?CJOJQJU^JmHnHujh;CJOJQJU^J%j3h;CJOJQJU^JHHHHHHH*I,I@IBIDINIPIRI`IbIvIxIzIIIIIIIIIIIܺܗܗܗqܗ^ܗK%j<h;CJOJQJU^J%hd 5B* CJOJQJ\^Jph%jY;h;CJOJQJU^J%j :h;CJOJQJU^JhLaSCJOJQJ^J%hLaS5B* CJOJQJ\^Jphh 2h 2CJOJQJ^J*jh?CJOJQJU^JmHnHujh;CJOJQJU^J%j7h;CJOJQJU^JHH*IRI5,# $Ifgd $Ifgd:+kd8$$IfTl4ִr Ewy!5%~*-2 I*    44 laf4TRI`IIIII"J $Ifgd:+ $IfgdIIIIIJJJJ J"J$J&J(J*JTJXJZJ㣗lVD"h_\h 25CJOJQJ\^J+h_\h 25B* CJOJQJ\^Jph.h_\h 25>*B* CJOJQJ\^Jphh 25CJOJQJ\^Jh 2h 2CJOJQJ^JhLaS*jh?CJOJQJU^JmHnHu%j)>h;CJOJQJU^J%hLaS5B* CJOJQJ\^JphhLaSCJOJQJ^Jjh;CJOJQJU^J"J$J&J5, $Ifgdkd?$$IfTl4ִr Ewy!5%~*-2 I*    44 laf4T&J(J*JXJZJLLLLLpCkdEC$$IfTl4~***44 laf4T $IfgdCkd@$$IfTl4~***44 laf4T ZJ\JxJzJ|JJJJJJJJJ>KJKPKTKVKrKtKvKKKKKKKKLL׾ׯwaK+jYBh_\h;CJOJQJU^J+jAh_\h;CJOJQJU^J+jmAh_\h;CJOJQJU^J%jh_\h;CJOJQJU^Jh_\hYvCJOJQJ^Jh_\h 2CJOJQJ^J1j@h_\h;5CJOJQJU\^J"h_\h 25CJOJQJ\^J+jh_\h;5CJOJQJU\^JLL:LLDLLLLLLMMM(M*M,M6M8M:M*B* CJOJQJ\^Jphh_\h 2CJOJQJ^J h_\h 2h_\hYvCJOJQJ^J+jBh_\h;CJOJQJU^Jh_\h 2CJOJQJ^J%jh_\h;CJOJQJU^JLLM:M,;K{Ad ?b}E]CѓVVXAj䍏RzD5#vFZ>1JۨW;RNg]@%SHHIW3Owm0m^ZFQr u%|TjCn fW: ($7u #i*[EA0Z+~!4^__%h\y劶[lߕ'&_x&Zx j#/m;v7Ek+)|w؁ P֬.m27 CZ l)XYG7EktqpftװR[¢2' -*F'45U )= ғ*,X97peō`KPYxЄ4JO] q|"C%43pMѲ`UڮP;yKaG@^abbK^qKRԺ^Ye6[-Ϫ!<\ ]'CVAiiUڔ`fa2]!slj1d j  5![KK?_ǝT4YSu~q7de58)QKB`،trQ1i)8Hgה-x{~W[VBOq?0jn~ =尰10 .'CAX8^[TɿZ89ZI|ő-\“L's+0 '׿3fw)>Q!6˥3@p>7Hyn3o(NuS;j8yvt?Nv$w"HfD10kC=8? íYqɘP N];W=jTR=%}sM}×Eeԭr7bX-aLl3eܹjl'-m;-I7! Vo_$}S~Q37VQ,EU9xc~$3R/bR(A1.`JsJa"QQ\\:€#/Ҡ\B' |ÀΠ6̮Ф{Ttgw#r=vM*;ƺ}hglo/i?@ ; .1"+{kLI?xs\;>;lhE_fR!IENDB`v$$If!vh5` 5 #v` #v :V l4*+,5` 5 / f4Tp$$If!vh5` 5 #v` #v :V l4*+5` 5 / f4TDd##L  C (A?squr_rdbhxWS@Dn<xWS@PNG  IHDR ?sBIT&C`PLTE{skcZRJB1tBbKGDH cmPPJCmp0712HsRIDATW%A @Qѩp|<Y4>=$Bj\yZn0W^WIENDB`Dd##L  C (A?squr_rdbhxWS@D n<xWS@PNG  IHDR ?sBIT&C`PLTE{skcZRJB1tBbKGDH cmPPJCmp0712HsRIDATW%A @Qѩp|<Y4>=$Bj\yZn0W^WIENDB`Dd##L  C (A?squr_rdbhxWS@D n<xWS@PNG  IHDR ?sBIT&C`PLTE{skcZRJB1tBbKGDH cmPPJCmp0712HsRIDATW%A @Qѩp|<Y4>=$Bj\yZn0W^WIENDB`G$$If!vh5*#v*:V l4*5*f4T\D#Text3YEnter the terminating employee's legal name, as shown on his or her social security card.Maximum field length is 35.D Text5FEnter the terminating employee's social security number (xxx-xx-xxxx).]Maximum field length is 11; spaces before and after the dashes are not allowed (xxx-xx-xxxx).D Text5FEnter the terminating employee's social security number (xxx-xx-xxxx).]Maximum field length is 11; spaces before and after the dashes are not allowed (xxx-xx-xxxx).$$If!vh55 555M5#v#v #v#v#vM#v:V l4 *,55 555M5/ / / f4ythTRD#YEnter the terminating employee's legal name, as shown on his or her social security card.Maximum field length is 35.$IfK$L$l!vh555#v#v#v:V l4 *,555/ f4ytcTX$$If!vh5*#v*:V l4 *,5*f4ytcTRD#YEnter the terminating employee's legal name, as shown on his or her social security card.Maximum field length is 35.D#FEnter the terminating employee's social security number (xxx-xx-xxxx).]Maximum field length is 11; spaces before and after the dashes are not allowed (xxx-xx-xxxx).$$If!vh5 55b5m#v #v#vb#vm:V l4 *,5 55b5m/ / f4ytcT DText170Enter the employee's effective termination date.Maximum field length is 18.$$If!vh55@ 5#v#v@ #v:V l4 *,55@ 5/ f4ytcTDtEnter the time of day the employee will terminate his or her employee if he or she is not to be paid for a full day.Maximum field length is 5.vDeCheck20vDeCheck21vDeCheck22tDeCheck9^DText8[Enter the number of hours the employee is to be paid for his or her last day of employment.Maximum field length is 4.$$If!vh55*5p55p5y#v#v*#vp#v#vp#vy:V l4*,55*5p55p5y/ / f4ythTH$$If!vh5*#v*:V l4*5*f4Tg$$If!vh51 5 #v1 #v :V l4*+51 5 f4T,D<FEnter the first line of the terminating employee's forwarding address.Maximum field length is 60.$$If!vh51 5555p#v1 #v#v5#vp:V l4 *+,51 5555p/ f4T.D<GEnter the second line of the terminating employee's forwarding address.Maximum field length is 60.$$If!vh51 5555p#v1 #v#v5#vp:V l4 *+,51 5555p/ f4T,D<FEnter the third line of the terminating employee's forwarding address.Maximum field length is 60.$$If!vh51 5555p#v1 #v#v5#vp:V l4 *+,51 5555p/ / / f4TvDeCheck10vDeCheck11vDeCheck12vDeCheck13R$$If!vh5*#v*:V l4*,5*f4TDText184Enter the terminating employee's primary rank/title.Maximum field length is 30.D:Enter the terminating employee's first date of employment.Maximum field length is 18.hDText19_Enter the current monthly salary associated with the terminating employee's primary rank/title.Maximum field length is 9.$$If!vh55 5\5T5 5i#v#v #v\#vT#v #vi:V l45*,55 5\5T5 5i/ / / f4T D6Enter the terminating employee's secondary rank/title.Maximum field length is 30.D:Enter the terminating employee's first date of employment.Maximum field length is 18.D $#,##0.00;($#,##0.00)aEnter the current monthly salary associated with the terminating employee's secondary rank/title.Maximum field length is 9.$$If!vh55 5\5T5 5i#v#v #v\#vT#v #vi:V l4*,55 5\5T5 5i/ / / f4TN$$If!vh5*#v*:V l4*,5*f4TTDText20TEnter the School/Unit associated with the terminating employee's primary rank/title.Maximum field length is 25.^D_Enter the name of the department associated with the terminating employee's primary rank/title.Maximum field length is 25.vD Text21eEnter the account number associated with the salary of the terminating employee's primary rank/title.Maximum field length is 10.4DKEnter the primary position number associated with the terminating employee.Maximum field length is 8.$$$If!vh555-52 5555I#v#v#v-#v2 #v#v#v#vI:V l4*,555-52 5555I/ / / / f4TLDVEnter the School/Unit associated with the terminating employee's secondary rank/title.Maximum field length is 25.bDaEnter the name of the department associated with the terminating employee's secondary rank/title.Maximum field length is 25.nD gEnter the account number associated with the salary of the terminating employee's secondary assignment.Maximum field length is 10.XD]Enter the position number of the secondary position associated with the terminating employee.Maximum field length is 8.$$$If!vh555-52 5555I#v#v#v-#v2 #v#v#v#vI:V l4*,555-52 5555I/ / / / f4TN$$If!vh5*#v*:V l4*,5*f4TvDeCheck14vDeCheck16vDeCheck17vDeCheck18vDeCheck19H$$If!vh5*#v*:V l4*5*f4TH$$If!vh5*#v*:V l4*5*f4TDText168Enter optional comments associated with the termination.Maximum field length is 400.Z$$If!vh5*#v*:V l4U*5*/ f4TV$$If!vh5*#v*:V l4*5*/ f4T$$If!vh515H5*5G #v1#vH#v*#vG :V l4*,515H5*5G / / / / f4Tz$$If!vh515H5q #v1#vH#vq :V l4*,515H5q f4T`$$If!vh5*#v*:V l4*,5*/  f4T$$If!vh5 5"5H5555g#v #v"#vH#v#v#v#vg:V l4*+++5 5"5H5555g/ / / / f4T$$If!vh5 5"5H5555g#v #v"#vH#v#v#v#vg:V l4*+++5 5"5H5555g/ / / f4yt( T$$If!vh5 5"5H5555g#v #v"#vH#v#v#v#vg:V l4*+++5 5"5H5555g/ f4ytYvT^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 Normal_HmH sH tH DA D Default Paragraph FontRi@R 0 Table Normal4 l4a (k ( 0No List 6U6  Hyperlink >*B*phHH .~ Balloon TextCJOJQJ^JaJNN .~Balloon Text CharCJOJQJ^JaJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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