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    Separating Employee Clearance Form: Department Authorized Representative

    Uploaded by

    Edwin Villa
    The document is a clearance form for separating employees at a university. It requires employees to return all university property like devices, cards, and keys before leaving. Departments are responsible for costs if property is not returned. The form must be completed by the employee and department manager to ensure the employee has cleared all obligations before their separation date.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Separating Employee Clearance Form: Department Authorized Representative

    Uploaded by

    Edwin Villa
    78 views1 page
    The document is a clearance form for separating employees at a university. It requires employees to return all university property like devices, cards, and keys before leaving. Departments are responsible for costs if property is not returned. The form must be completed by the employee and department manager to ensure the employee has cleared all obligations before their separation date.

    Original Description:

    law

    Original Title

    2016 Clearance of Campus FINAL

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    The document is a clearance form for separating employees at a university. It requires employees to return all university property like devices, cards, and keys before leaving. Departments are responsible for costs if property is not returned. The form must be completed by the employee and department manager to ensure the employee has cleared all obligations before their separation date.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    78 views1 page

    Separating Employee Clearance Form: Department Authorized Representative

    Uploaded by

    Edwin Villa
    The document is a clearance form for separating employees at a university. It requires employees to return all university property like devices, cards, and keys before leaving. Departments are responsible for costs if property is not returned. The form must be completed by the employee and department manager to ensure the employee has cleared all obligations before their separation date.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    SEPARATING EMPLOYEE CLEARANCE FORM

    A clearance form is required for all separating employees, including any employee who receives notification of reassignment. Employees
    are required to return all University property such as electronic devices, laptop computers, cell phones, P-Card, building access cards,
    keys and equipment prior to separating or other applicable circumstances such as reassignment. Departments are responsible for costs
    associated with the failure to secure University property and resources upon separation of an employee or other applicable circumstance.
    Department manager is responsible for ensuring the employee is cleared where applicable & returning completed form to HR.

    Separation Date: _________________________________ Type of Clearance: Reassigned Separation


    Employee Last Name: First Name: ______________________________

    Department/College: Title: ___________________________________

    Forwarding Address: Telephone: _______________________________

    Email Address: _______________________________________________ ADP ID#: ________________________________

    I certify the information I have furnished on this form is true, correct, and complete to the best of my knowledge. I understand the University or its
    representatives may audit the information I supplied. It is my responsibility to provide the most accurate forwarding information including my address,
    phone numbers, and other contact information and to ensure I am cleared from any University obligations such as fees, returning equipment,
    Purchase Cards (P-Cards, etc.). Further, I understand upon separation that I have an ongoing responsibility to maintain the confidentiality of any
    student and/or employee information, as well as any intellectual property I may have had access to during my employ with the University.

    _____________________________________________ _______________________________________ _____________


    Print Employee Name Employee Signature Date

    Department Authorized Representative


    Submit Separating Employee Information to Human Resources (Resignation Notice, Initials: __________________

    Acceptance of Resignation, Letter of Separation, PAF or Electronic Separation Event, etc.). Applicable? Print Name: ______________
    Electronic Equipment (Laptop, Tablet, iPad, Cellular Device, Thumb Drives, etc.). Yes No Date:____________________
    University/Department owned/issued equipment (Tools, Uniforms, Keys.).

    Public Safety Authorized Representative


    Department Keys & Parking Decal Applicable/Received? Initials: _________ Print Name: ____________ Date:__________
    (Office, Building, Vehicle, Locker, etc.).
    Citations/Parking or Associated Fees Yes No

    Accounting & Procurement Authorized Representative


    Purchase Card/P-Card (Procurement) Applicable/Received? Initials: _________ Print Name: ___________ Date:___________
    Yes No
    Travel/Reimbursement/Fees (Accounting) Yes No Initials: _________ Print Name: ___________ Date: ___________

    University Authorized Representative


    Library Items/Fees (Library) Applicable/Received? Initials: _________ Print Name: ___________ Date:___________
    Yes No
    Laker Card (Laker Card Center) Yes No Initials: _________ Print Name: ___________ Date: __________

    Human Resources (For HR Use & Processing Only)


    DOL Separation Notice, PAF/ Electronic Action, Internal Separation Notice, Letter of Separation/Resignation w/Acceptance, Payroll/Benefits Notification

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