R∙I∙T Department of Human Resources Employee Action Form TERMINATION Return form to Human Resources as soon as a termination date is known Last Name: First Name: Employee # Address: City: State Zip Code Termination Date (MM/DD/YYYY): _
Termination Reason (choose one) Another Job Layoff Deceased LTD Benefits Ended Discharged Relocation End of Contract Retirement Family Responsibility Return to School Gross Misconduct Resignation‐Other ______________________________________________________________ Eligible Vacation Days (Exempt staff only): # Carryover # Used Non­exempt staff vacation will be received from Kronos by the Department of Human Resources. Remarks/Special Pay Instructions: Please include a copy of resignation letter with this form. Also, you must complete the termination checklist on the HR web site at: http://finweb.rit.edu/humanresources/forms/terminationchecklist.pdf and return it to Human Resources. Does this employee supervisor others: Yes No Signatures Completed By _______________________________________________________________ Ext._______ Date
1st Approval (required) _____________________________________________________ Ext._______ Date 2nd Approval (optional)__________________________________________________________________ Date 3rd Approval (optional) __________________________________________________________________ Date
Required Signatures ­ Grants Only Principal Investigator ________________________________ Ext. ___________ Date___/___/___ Accounting Representative ___________________________________________ Date___/___/___ Revised 11/12/09