Employment Termination Checkout Form

EMPLOYMENT TERMINATION CHECKOUT FORM
Full-time Faculty, Administrative and Staff Personnel
Brigham Young University
Name:______________________________________________ BYU ID:__________________________________________
Termination Date (Fac / Admin / ATH / Staff): ______________Final Check Date (Fac / Admin / ATH /Staff): ______________
STEP 1: BENEFITS OFFICE: Go to the Benefits Office (D-240, ext 2-4716) for a discussion of post-termination benefits.
___ Check Current Class Enrollment Status (Tuition Benefit)
___ Medical Insurance/COBRA ___ Update ID card Status
___ Flexible Spending Account (FSA) ___ Mailing Address in Personal Information (PI)
___ Savings Plan Options ___ Copy of Checkout Form to Payroll
___ Loans ___ Copy of Checkout Form to Faculty /Athletic Professional Personnel
___ Master Retirement ___ Send Termination Email
BENEFITS OFFICE CLEARANCE: __________________________________/____________
(Authorized Signature) (Date)
STEP 2: EXIT SURVEY: Before you depart, we would appreciate receiving feedback regarding various aspects of your employment
experience. Please complete a survey at: http://byu.qualtrics.com/SE/?SID=SV_3IY7elGxzRoGJFO&SVID=Prod
STEP 3: CAMPUS SERVICES: The Benefits Office will notify the following offices of your termination. Please resolve all matters
with these personal service departments before leaving the University.
___ Bookstore (ext. 2-2470) Complete payment for all personal Bookstore accounts or contracts and
return personal Bookstore charge card to Bookstore Customer Service.
___ Financial Services (ext. 2-4104) Complete payment of all Employee Accounts due to BYU.
___ Key Office (ext. 2-5521) Return outstanding keys.
___ Library/LRC’s (ext. 2-5634 or 2-6061) Return all library books and materials and pay any fines.
___ Purchasing Card (ext. 2-4702) Account for outstanding transactions.
___ Remembrance Fund Participants (ext. 2-6641) Notify Financial Services of termination date.
___ Signature Card (ext. 2-7829) Account to department for outstanding department transactions.
___ Travel Card (ext. 2-8246) Account for outstanding transactions.
PERSON TERMINATING EMPLOYMENT: __________________________________/____________
(Signature) (Date)
STEP 4: TRAFFIC OFFICE: Go to the Traffic Office (2120 JKB); notify of termination date, and resolve any outstanding citations.
TRAFFIC OFFICE CLEARANCE: __________________________________/____________
(Authorized Signature) (Date)
This form will lead you through the checkout process as you terminate employment and leave the University. The process begins
with the Benefits Office and ends with your own Department. You should start the process about a week before your final work
day. Completing these items will result in a smooth transition for you, for your department, and for the university administrative
systems in which you have had access rights as an employee.
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