Termination Notification Form
SECTION A: Leaving Government of Saskatchewan or
SECTION B: Terminating an Assignment
For an employee taking a leave from an assignment for a term position, please complete a Leave of Absence
Request Form and see Manager Checklist – Definite LOA for Term Position Checklist.
On completion, forward form to the Human Resource Service Centre (HRSC)
Employee Name:
Employee #:
Employee Home Address:
No. & Street
City/Town
Postal Code
Assignment #:
Ministry:
Branch:
Manager / Supervisor Name:
Phone #:
SECTION A:
Leaving Government of Saskatchewan
Last Day Worked:
/
/
Pay Period Ending:
DD / MON / YYYY
Last Effective Day of Employment:
/
/
/
(may be the same as last day worked including EDO/SDO/SDR)
(may be the date Labour Service recall was declined)
DD / MON / YYYY
EDO choose one:
/
DD / MON / YYYY
Office
Field
N/A
Date of Last EDO:
/
/
DD / MON / YYYY
MIDAS Reason for Termination Please choose one:
Inv - Abandonment
Inv - Separation without Cause (Out-of-Scope)
Inv - Bumped - No Re-Emp Rights (In-Scope)
Inv - Student Term End (Student-Summer, Student-Co-op)
Inv - Bumped - Re-Emp Rights (In-Scope)
Inv - Termination with Cause
Inv - Bumped - Retirement (In-Scope)
Inv - Termination of Contract (Contract Employee)
Inv - Bumped - Resignation with Severance (In-Scope)
Inv - Transfer out of Public Service with Re-Emp Rights
Inv - Death (ATTENTION BENEFIT SERVICES TEAM)
Vol - Accept New Position Outside of Public Service
Inv - Expiry of Non Perm Appointment (Includes End of
Vol - Accept Position with Crown Corp/Agency
Student-Less than Full-Time Term)
Vol - Decline Position Transfer
Inv - Failed Probation
Vol - Non Student Return to School (PFT, PPT, Term,
Inv - Health Reasons
Student-Less than Full-Time, ending employment to go to
Inv - Inactive for more than 180 days
school -- NOT for Student-Summer, Student-Co-op)
Inv - Layoff - No Re-Emp Rights (In-Scope)
Vol - Personal Reasons
Inv - Layoff - Re-Emp Rights (In-Scope)
Vol - Spouse Relocated
Inv - Layoff - Resignation with Severance (In-Scope)
Ret - Retirement - Voluntary
Inv - Layoff - Retirement with Severance (In-Scope)
SECTION B: Terminating an Assignment
Note: Still an employee of the Government of Saskatchewan
Last Day Worked:
Pay Period Ending:
/
/
DD / MON / YYYY
/
/
DD / MON / YYYY
Last Effective Day of Employment:
/
/
Ministry employee commencing in:
DD/ MON / YYYY
may be the same as last day worked, include EDO/SDO/SDR if it falls on last day
Outstanding debt to be collected
Yes
No
Note: Please include any outstanding Return in Service Commitment
If yes, please indicate amount outstanding:
Reason:
Manager / Supervisor:
Date:
REMINDER:
Obtain employee’s alternative email address. Refer to Manager Checklists on termination
http://esc.psc.gov.sk.ca/managers/Pages/Termination.aspx for a complete listing of information that is required for the
completion of the Exit Survey.
Termination Notification Form
Page 1 of 1
4-Apr-2017