Preview Employee Exit Clearance Form

EMPLOYEE EXIT CLEARANCE FORM

Employee Name: ________________________________________

UNC Charlotte ID Number: ________________________________

Requirement prior to separation:

Obtain clearance and authorized signature from the following departments

Department

Authorized Signature

Departmental

 University ID cards, keys, uniforms,

tools/equipment (such as cell phones or lap top

computers), phone cards, purchasing cards, all

petty cash items (receipts and cash), and other

university property returned

 Departmental computer access terminated

 Leave accounting coordinated with Payroll

______________________________

Supervisor Signature

Library

 Materials returned

 No outstanding fines

______________________________

Library Signature

Parking Services

 Decal and ID have been returned

 No outstanding fines

______________________________

Parking Services Signature

Travel & Complex Payments

 No outstanding travel advances, fees, etc.

______________________________

Travel & Complex Signature

Student Accounts (if taking classes)

 No outstanding account balance

______________________________

Student Accounts Signature

Benefits Department

 Benefits information provided

 Exit clearance form received

______________________________

Benefits Signature

Revised 10-31-2016

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