Employee Separation Notice

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Employee Name Employee Social Security Number Type and Reason for Termination/Separation (Please check all that apply) Voluntary Termination: Another Job No Notice Given Unknown No Call, No Show Walk Out Other: Personal Reasons Relocated/Moved Lack of Work/Lay Off Position Eliminated Time Theft Falsification of Records Other: Insubordination Positive Drug Screen Company Closed Deceased Involuntary Termination: Replaced/Not a Good Fit Theft Failure to Perform Job Duties Excessive Absenteeism/Tardiness Administrative Termination Explanation or Additional Comments: Date Authorized Signature Title.

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