ࡱ> '` Qbjbj v 4    |+x\\0`+++++++$,h.8;+]!!!;++%%%!+%!+%%%l `WB !%1&+0+%4/!4/%4/%L 0| "%  L L L ;+;+[%:L L L +!!!!    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      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: FORMTEXT      Dept.: FORMTEXT      AIS Budget Purpose: FORMTEXT      Position Number: FORMTEXT    "(efg 즚|i|V||C%j{ h5CJOJQJU\^J%js h5CJOJQJU\^J%jkh5CJOJQJU\^Jhd 5CJOJQJ\^Jh:+5CJOJQJ\^JhCJOJQJ^Jh6CJOJQJ]^JhCJOJQJ^Jh5CJOJQJ\^JhV5CJOJQJ\^Jh5OJQJ\^J hCJjhCJUh:+ !"<fSkde$$IfTl40 ~*`  *4 laf4T $$Ifa$gd $IfgdQfgh    $IfgdV $$Ifa$gd $IfgdgdSkd$$IfTl40 ~* `  *4 laf4T     ' ( 2 3   : < P R T ^ ` b v x Ǵ葤{nʹ[{H%h65B* CJOJQJ\^Jph%j6hCJOJQJU^J *hCJOJQJ^J*jh?CJOJQJU^JmHnHu%jhCJOJQJU^JjhCJOJQJU^J%h5B* CJOJQJ\^Jph hCJh5CJOJQJ\^Jh:+CJOJQJ^JhCJOJQJ^Jh6CJOJQJ^J ! '   : b x $Ifgdgd@kd$$IfTl4~***4 laf4T x z      & ( * ﮨpjW%jh6CJOJQJU^J h6CJ%jh6CJOJQJU^J%h65B* CJOJQJ\^Jph h:+CJh:+CJOJQJ^J hCJhCJOJQJ^J*jh?CJOJQJU^JmHnHu%jh6CJOJQJU^Jh6CJOJQJ^Jjh6CJOJQJU^J LC $Ifgd:+kd$$IfTl4 ֞V )f#~* =*4 laf4T Efkd$$IfTl4 F~* a*    4 laf4T $Ifgd $Ifgd:+@kd$$IfTl4 ~***4 laf4T  * , $Ifgd $$Ifa$gd:+ $Ifgd:+@kd$$IfTl4 ~***4 laf4T* , H J L ^ ` | ~ , > @ \ ^ ` ݫݒscsMcscs+jh?h?CJOJQJU^Jjh6CJOJQJU^Jh6CJOJQJ^J%h65B* CJOJQJ\^Jph1jh?h?5CJOJQJU\^J1jh?h?5CJOJQJU\^J1jh?h?5CJOJQJU\^Jh65CJOJQJ\^J%jh65CJOJQJU\^J ٷ}nnٷ[ٷnٷ%jxh6CJOJQJU^Jh65CJOJQJ\^JhVCJOJQJ^J%h65B* CJOJQJ\^Jph(h65>*B* CJOJQJ\^Jph h6CJh6CJOJQJ^J*jh?CJOJQJU^JmHnHujh6CJOJQJU^J+jnh6h6CJOJQJU^J _V $Ifgdkd$$IfTl4 ֈC(~*Nppy*4 laf4T cWW $$Ifa$gdSkd$$IfTl40 ~*`1  *4 laf4T $Ifgd>kd$$IfTl4~***4 laf4T|p|p $$Ifa$gd $Ifgdykd$$IfTl4 \ %~* 1 5p*4 laf4T   "$8:<FHLNPprܺܺܺ}jܺTܺHܺhd CJOJQJ^J+j0#h?h?CJOJQJU^J%h65B* CJOJQJ\^Jph(h65>*B* CJOJQJ\^Jph%j6!h6CJOJQJU^Jh65CJOJQJ\^J h6CJh6CJOJQJ^J*jh?CJOJQJU^JmHnHujh6CJOJQJU^J%jVh6CJOJQJU^J "JL|p|p $$Ifa$gd $Ifgdykd $$IfTl4 \ %~* 1 5p*4 laf4TLNP|||;|@kd%$$IfTl4~***4 laf4T $Ifgdykdb"$$IfTl4 \ %~* 1 5p*4 laf4T<>HJfhjp~  ͕ͫ͆mZD*jh?CJOJQJU^JmHnHu%je%h6CJOJQJU^J%h65B* CJOJQJ\^Jph h6CJh65CJOJQJ\^J+j$h?h?CJOJQJU^J+j$h?h?CJOJQJU^Jhd CJOJQJ^Jh6CJOJQJ^Jjh6CJOJQJU^J+j#h?h?CJOJQJU^J,02FHJTVXhvнoнooнYSo h6CJ+j'hQh6CJOJQJU^J%h 25B* CJOJQJ\^Jphh65CJOJQJ\^J*jh?CJOJQJU^JmHnHu+jy&hQh6CJOJQJU^J%h65B* CJOJQJ\^Jph%hV5B* CJOJQJ\^Jphh6CJOJQJ^Jjh6CJOJQJU^J0XJkd($$IfTl45ֈA#~* \T i*4 laf4T $$Ifa$gdQ $Ifgd  02FHJTVX(rllY%hE 5B* CJOJQJ\^Jph h 2CJ%j ,h 2CJOJQJU^Jh 25CJOJQJ\^J%j*h 2CJOJQJU^J%h 25B* CJOJQJ\^Jph*jh?CJOJQJU^JmHnHu%j)h 2CJOJQJU^Jh 2CJOJQJ^Jjh 2CJOJQJU^J0XAkd-$$IfTl4ֈA#~* \T i*4 laf4T $$Ifa$gd 2 $Ifgd:+ $Ifgd:Hp H>kd.$$IfTl4~***4 laf4T $Ifgd (*,68:HJ^`blnpxܺܺܺnܺXܺnܺ+j1hzh 2CJOJQJU^J%hLaS5B* CJOJQJ\^Jph%hd 5B* CJOJQJ\^Jph%j60h 2CJOJQJU^J%h 25B* CJOJQJ\^Jphh 2CJOJQJ^J*jh?CJOJQJU^JmHnHujh 2CJOJQJU^J%j.h 2CJOJQJU^JHHH H H@HBHVHXHZHdHfHhHvHxHHHHHHHHHHٵmÌZÌG%hd 5B* CJOJQJ\^Jph%j6hLaSCJOJQJU^J%jm5hLaSCJOJQJU^JhLaSCJOJQJ^JjhLaSCJOJQJU^J%hLaS5B* CJOJQJ\^Jph h 2CJh 2CJOJQJ^JU*jh?CJOJQJU^JmHnHujh 2CJOJQJU^J+j 3hzh 2CJOJQJU^J   School, College, or Unit: FORMTEXT      Dept.: FORMTEXT      AIS Budget Purpose: FORMTEXT      Position Number: FORMTEXT       REASON FOR SEPARATION:  FORMCHECKBOX  Appointment Expiration  FORMCHECKBOX  Retirement  FORMCHECKBOX  Accepting position elsewhere  FORMCHECKBOX  Resignation  FORMCHECKBOX  Deceased  FORMCHECKBOX  OtherComments:  FORMTEXT      NOTE: The Office of the Chancellor encourages employees resigning or retiring from SIUE to schedule a personal exit interview with the supervisor of the employee's immediate supervisor. SUBMITTED BY:DATE:Employee's SignaturePlease sign and make a file copy before forwarding. The Office of Human Resources WILL NOT be sending copies of this document. >> SIGN WITH BLUE INK << >> SIGN WITH BLUE INK << >> SIGN WITH BLUE INK <<ACCEPTED BY:Chair/SupervisorDateDean/Director/Fiscal OfficerDateChair/SupervisorDateDean/Director/Fiscal OfficerDateVice ChancellorDateVice ChancellorDateChancellorDateDirector, Human Resources Date04/08 H H@HhHvH90'' $Ifgd $Ifgd:+kd>4$$IfTl4ִr Ewy!5%~*-2 I*    4 laf4TvHHHHI8I $Ifgd:+ $IfgdHHHHHHHII&I(I*I4I6I8I:II@IjInIpIθθ}whS@h%h 25B* CJOJQJ\^Jph(h 25>*B* CJOJQJ\^Jphh 25CJOJQJ\^J h 2CJh 2CJOJQJ^J hLaSCJ+j9hzhLaSCJOJQJU^J%hLaS5B* CJOJQJ\^Jph*jh?CJOJQJU^JmHnHujhLaSCJOJQJU^J+j8hzhLaSCJOJQJU^JhLaSCJOJQJ^J8I:II@InIpIpKrKtKx>kd-?$$IfTl4~***4 laf4T $Ifgd>kd<$$IfTl4~***4 laf4TpIrIIIIIIIIII*J,JHJJJLJJJJJJJJKKKKZKݸ|fP+jA>h?h?CJOJQJU^J+j=h?h?CJOJQJU^J+jU=h?h?CJOJQJU^J+j<h?h?CJOJQJU^Jjh 2CJOJQJU^Jh 2CJOJQJ^J1ji<h?h?5CJOJQJU\^Jh 25CJOJQJ\^J%jh 25CJOJQJU\^JZK\K^KpKrKtKvKKKKKKKKKKKKHMJMhMjMvMxMzM|MMMMNǻǦ̀j[Ǔ[[[[K *h 25CJOJQJ\^Jh 25CJOJQJ\^J*jh?CJOJQJU^JmHnHu%j?h 2CJOJQJU^J%h 25B* CJOJQJ\^Jph(h 25>*B* CJOJQJ\^Jphh 2CJOJQJ^J h 2CJh 2CJOJQJ^Jjh 2CJOJQJU^J+j>h?h?CJOJQJU^JtKvKKKKLHMv@kd@$$IfTl4U~***4 laf4T $Ifgd>kd?$$IfTl4~***4 laf4THMJMLMhMjMvMxMzM?wkdA$$IfTl4\ 7!~*1H*G *4 laf4T $Ifgd>kdVA$$IfTl4~***4 laf4TzM|MMMMNNOy $$Ifa$gdgdkdB$$IfTl4F ~*1Hq *    4 laf4T $$Ifa$gd $IfgdN&NNOOOOOOOnPpPPPBQDQQQQQQQQQQQQ̷ߖ~~zhhd CJOJQJ^Jh:+CJOJQJ^Jh 2CJOJQJ^Jh 25CJOJQJ\^J h 2CJ( *h 25B*CJOJQJ\^Jph%h 25B*CJOJQJ\^Jph *h 25CJOJQJ\^J *hV5CJOJQJ\^JOOOOOOOOO $Ifgd@kdC$$IfTl4~** *4 laf4TOOPP&P(PbPdPLCCCCCC $IfgdkdzC$$IfTl4֞s  #$~* `"H``g*4 laf4TdPnPpPPPPPPCkdD$$IfTl4֞s  #$~*  "H  g*4 laf4T $IfgdPPPPQ QQQCkdE$$IfTl4֞s  #$~*  "H  g*4 laf4T $IfgdQ6Q8QBQDQZQ\QfQCkdG$$IfTl4֞s  #$~*  "H  g*4 laf4T $IfgdfQhQQQQQQE9 $$Ifa$gdkdhH$$IfTl4֞s  #$~*  "H  g*4 laf4T $IfgdQQQQQupgd:+>kdI$$IfTl4~***4 laf4T $$Ifa$gdE>kdbI$$IfTl4~***4 laf4T,&P/ =!h"h#$% / 0&P/ =!h"h#$% 5 0&P:p:+/ =!h"h#$% eDdT  C 0Alogo_150_btb%ǏnZPѧȂa\Dn%ǏnZPѧȂa\PNG  IHDR VtRNS["bKGD̿ cmPPJCmp0712`IDATXGXu8 oqsq3X ':A '8z>,;K{Ad ?b}E]CѓVVXAj䍏RzD5#vFZ>1JۨW;RNg]@%SHHIW3Owm0m^ZFQr u%|TjCn fW: ($7u #i*[EA0Z+~!4^__%h\y劶[lߕ'&_x&Zx j#/m;v7Ek+)|w؁ P֬.m27 CZ l)XYG7EktqpftװR[¢2' -*F'45U )= ғ*,X97peō`KPYxЄ4JO] q|"C%43pMѲ`UڮP;yKaG@^abbK^qKRԺ^Ye6[-Ϫ!<\ ]'CVAiiUڔ`fa2]!slj1d j  5![KK?_ǝT4YSu~q7de58)QKB`،trQ1i)8Hgה-x{~W[VBOq?0jn~ =尰10 .'CAX8^[TɿZ89ZI|ő-\“L's+0 '׿3fw)>Q!6˥3@p>7Hyn3o(NuS;j8yvt?Nv$w"HfD10kC=8? íYqɘP N];W=jTR=%}sM}×Eeԭr7bX-aLl3eܹjl'-m;-I7! Vo_$}S~Q37VQ,EU9xc~$3R/bR(A1.`JsJa"QQ\\:€#/Ҡ\B' |ÀΠ6̮Ф{Ttgw#r=vM*;ƺ}hglo/i?@ ; .1"+{kLI?xs\;>;lhE_fR!IENDB`$$If!vh5` 5 #v` #v :V l4*+,5` 5 / 4f4T~$$If!vh5` 5 #v` #v :V l4*+5` 5 / 4f4TDdL  C (Asqur_rdbh:jJ~9~DDn<:jJ~9~DPNG  IHDR ?sBIT&C`PLTE{skcZRJB1tBbKGDH cmPPJCmp0712HsRIDATW%A @Qѩp|<Y4>=$Bj\yZn0W^WIENDB`DdL  C (Asqur_rdbh:jJ~9~DD n<:jJ~9~DPNG  IHDR ?sBIT&C`PLTE{skcZRJB1tBbKGDH cmPPJCmp0712HsRIDATW%A @Qѩp|<Y4>=$Bj\yZn0W^WIENDB`DdL  C (Asqur_rdbh:jJ~9~DD n<:jJ~9~DPNG  IHDR ?sBIT&C`PLTE{skcZRJB1tBbKGDH cmPPJCmp0712HsRIDATW%A @Qѩp|<Y4>=$Bj\yZn0W^WIENDB`U$$If!vh5*#v*:V l4*5*4f4T\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). $$If!vh55 5555=5#v#v #v#v#v#v=#v:V l4 *,55 5555=5/ / / 4f4T[$$If!vh5*#v*:V l4 *,5*4f4T DText170Enter the employee's effective termination date.Maximum field length is 18.$$If!vh55 5a#v#v #va:V l4 *,55 5a/ 4f4T[$$If!vh5*#v*:V l4 *,5*4f4TDtEnter 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.$$If!vh55N5p55p5y#v#vN#vp#v#vp#vy:V l4 *,55N5p55p5y/ / 4f4TQ$$If!vh5*#v*:V l4*5*4f4Tp$$If!vh51 5 #v1 #v :V l4*+51 5 4f4T,D<FEnter the first line of the terminating employee's forwarding address.Maximum field length is 60.$$If!vh51 5555p#v1 #v#v5#vp:V l4 *+,51 5555p/ 4f4T.D<GEnter the second line of the terminating employee's forwarding address.Maximum field length is 60.$$If!vh51 5555p#v1 #v#v5#vp:V l4 *+,51 5555p/ 4f4T,D<FEnter the third line of the terminating employee's forwarding address.Maximum field length is 60.$$If!vh51 5555p#v1 #v#v5#vp:V l4 *+,51 5555p/ / / 4f4TvDeCheck10vDeCheck11vDeCheck12vDeCheck13[$$If!vh5*#v*:V l4*,5*4f4TDText184Enter the terminating employee's primary rank/title.Maximum field length is 30.D:Enter the terminating employee's first date of employment.Maximum field length is 18.hDText19_Enter the current monthly salary associated with the terminating employee's primary rank/title.Maximum field length is 9.$$If!vh55 5\5T5 5i#v#v #v\#vT#v #vi:V l45*,55 5\5T5 5i/ / / 4f4T 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.$$If!vh55 5\5T5 5i#v#v #v\#vT#v #vi:V l4*,55 5\5T5 5i/ / / 4f4TW$$If!vh5*#v*:V l4*,5*4f4TTDText20TEnter 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.-$$If!vh555-52 5555I#v#v#v-#v2 #v#v#v#vI:V l4*,555-52 5555I/ / / / 4f4TLDVEnter the School/Unit associated with the terminating employee's secondary rank/title.Maximum field length is 25.bDaEnter the name of the department associated with the terminating employee's secondary rank/title.Maximum field length is 25.nD gEnter the account number associated with the salary of the terminating employee's secondary assignment.Maximum field length is 10.XD]Enter the position number of the secondary position associated with the terminating employee.Maximum field length is 8.-$$If!vh555-52 5555I#v#v#v-#v2 #v#v#v#vI:V l4*,555-52 5555I/ / / / 4f4TW$$If!vh5*#v*:V l4*,5*4f4TvDeCheck14vDeCheck15vDeCheck16vDeCheck17vDeCheck18vDeCheck19Q$$If!vh5*#v*:V l4*5*4f4TQ$$If!vh5*#v*:V l4*5*4f4TDText168Enter optional comments associated with the termination.Maximum field length is 400.c$$If!vh5*#v*:V l4U*5*/ 4f4T_$$If!vh5*#v*:V l4*5*/ 4f4T$$If!vh515H5*5G #v1#vH#v*#vG :V l4*,515H5*5G / / / / 4f4T$$If!vh515H5q #v1#vH#vq :V l4*,515H5q 4f4Ti$$If!vh5*#v*:V l4*,5*/  4f4T $$If!vh5 5"5H5555g#v #v"#vH#v#v#v#vg:V l4*+++5 5"5H5555g/ / / / 4f4T<$$If!vh5 5"5H5555g#v #v"#vH#v#v#v#vg:V l4*+++5 5"5H5555g/ / / / / / 4f4T<$$If!vh5 5"5H5555g#v #v"#vH#v#v#v#vg:V l4*+++5 5"5H5555g/ / / / / / 4f4TN$$If!vh5 5"5H5555g#v #v"#vH#v#v#v#vg:V l4*+++,,,5 5"5H5555g/ / / / / / 4f4T$$If!vh5 5"5H5555g#v #v"#vH#v#v#v#vg:V l4*+++,5 5"5H5555g/ 4f4TW$$If!vh5*#v*:V l4*,5*4f4TW$$If!vh5*#v*:V l4*,5*4f4T8@8 Normal_HmH sH tH DA@D Default Paragraph FontRi@R  Table Normal4 l4a (k(No List6U@6  Hyperlink >*B*phh! v.v_v !"<fgh !';<QepJv  !-AL`u%9:Tho   =   ) * + , - . / 0 A B G H e f k l } ~      000 0 0 0 00 0 00000000 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 000 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0000 0 0 0 00 0 00 0 00 0 0 0 0 0 0 0 0 000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 x * (HpIZKNQ "#+./3f L HvH8I?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`acdefghijklmnopqrstuvwxy{|}~Root Entry FP\BData <J1Tableb4/WordDocumentvSummaryInformation(zDocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q