Last Name
First Name
Department
Effective Date
Type of Separation Resignation - if resigned, attach letter of resignation Retirement Mutual Dismissal Lay-off Other
If laid off, approximate return date
Other Separation Reason
Date of notice given
Notice given by
Reason for separation - check one Absenteeism or Lateness Health Other Reduction in Forces Changed Job Incompetence Personal
Remove from schedule week beginning
OVERALL EVALUATION OF EMPLOYEE WHILE AT ZEHNDER'S
Attendance ExcellentGoodSatisfactoryImprovement NeededUnsatisfactory
Cooperation ExcellentGoodSatisfactoryImprovement NeededUnsatisfactory
Work Quantity ExcellentGoodSatisfactoryImprovement NeededUnsatisfactory
Job Knowledge ExcellentGoodSatisfactoryImprovement NeededUnsatisfactory
Work Quality ExcellentGoodSatisfactoryImprovement NeededUnsatisfactory
Recommendation Without Reservation With Some Reservation Would Not Recommend
Rehire? Yes No
Supervisor's Comments
Supervisor's Signature - Please type first and last name
Employee Comments
THIS 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 Signature - Please type first and last name
