Termination Report

Name*
First Last
Location Worked*
Pick the store the employee was assigned
Last Day Worked*
Date Format: MM slash DD slash YYYY
Termination Date*
Date Format: MM slash DD slash YYYY
Type of Separation*
Quit / Resignation*
What reason did employee give for quitting?
Employee
- Turned in keys
- Turned in uniform
- Missed scheduled shifts
- Made no further contact
Quit / Resignation explanation
Please note any actions or comments by employee indicating intent to quit
Please identify what attempts were made to contact employee
Reason for Dismissal
- Absenteeism / Lateness
- Incompetence
- Theft
- Other
Please describe the final incident resulting in the dismissal of the employee
Written / Verbal Warnings
If Written warnings were given, verify that they have been sent to main office If verbal warnings were given, please identify: Date, Given by, and Work Issue
Other reason for Separation
Example: death of employee
Is this employee rehireable?*
Is this employee allowed to be rehired?
Manager Name*
First Last
File
Signature*
Sign your name