Use this form when terminating an academic employee from the Payroll/Personnel System, i.e. when an employee will be leaving the University.
Top Section
|
Field Name |
Instruction |
|
STATUS |
Circle the appropriate category. |
|
NAME |
Enter the academic employee’s full last and first name; the middle initial is optional. |
|
SSN |
Enter the academic employee’s social security number. |
|
JOB CODE |
Enter the 6-digit job code. |
|
JOB TITLE |
Enter the Job Title for the above Job Code. |
|
DEPT. NO. |
Enter the 5-digit Department Number (List only the Responsible Department). |
|
DEPT. NAME |
Enter the name of the Department, corresponding with the Dept. No. above. |
|
Field Name |
Instruction |
|
EFFECTIVE DATE |
Enter the date of termination, i.e. first day without pay. |
|
LAST DAY WORKED |
Enter the last day of the appointment, i.e. last day physically of the job. |
|
TERMINATION ACTION CODE |
The appropriate Termination Code is entered. |
|
TERMINATION REASON CODE |
Enter the appropriate Termination Reason Code. The codes are listed below this field. |
|
UOFC PROPERTY RETURN |
Check either Yes or No. |
Personal Data
|
Form Field Name |
Instruction |
|
FORWARDING ADDRESS |
Enter a complete forwarding address. Note that this is the mailing address for University correspondence, such as the W-2 form. |
Approvals Section
Obtain all necessary signatures before forwarding this form to the Provost’s Office.
Missing approval signatures will delay processing of the academic employee.