Employee Separation Report Employee Separation Report Please complete the form below. Last NameFirst NameDepartmentLast 4 digits of social security numberEmployee NumberEffective Date MM slash DD slash YYYY Type of Seperation Resignation (attach letter of resignation) Retirement Mutual Agreement Dismissal Lay-off (approximate return date) Other Date of Notice Given MM slash DD slash YYYY ByReason for Separation Absenteeism/Lateness Health Reduction in Forces Changing Job Incompetence Personal Reason Other Remove from schedule week beginningOverall Evaluation of Employee while at Zehnder'sAttendance Excellent Good Satisfactory Improvement Needed Unsatisfactory Cooperation Excellent Good Satisfactory Improvement Needed Unsatisfactory Work Quantity Excellent Good Satisfactory Improvement Needed Unsatisfactory Job Knowledge Excellent Good Satisfactory Improvement Needed Unsatisfactory Work Quality Excellent Good Satisfactory Improvement Needed Unsatisfactory Recommendation Without Reservation With Some Reservation Would not Recommend Rehire Yes No Other Final Paycheck Self Pick-up Mail Hold in Office Supervisor's CommentsSupervisor's Signature (type first and last name)Date MM slash DD slash YYYY Witness's Signature (type first and last name)Date MM slash DD slash YYYY Employee's CommentsThis Separation has been Reviewed with me I give permission to use this report as reference for prospective employers. I do not give permission to use this report as a reference for prospective employers. Employee's Signature (please type first and last name)Date MM slash DD slash YYYY CAPTCHA
