HTML Preview Printable Work Separation Notice page number 1.
OSU INSTITUTE OF TECHNOLOGY
SEPARATION NOTICE
Salary Resignation
Hourly Dismissal
Federal Work Study Retirement
Institutional Work Study Death
End of assignment
NAME
CWID #
POSITION
DEPARTMENT NAME
FORWARDING ADDRESS
Street City State Zip-code
CLOSING HOUR OF AM
ACTUAL SERVICE PM
Month Day Year
EARNED LEAVE DUE AL HOURS EFFECTIVE DATE
SL HOURS Paid Through
CT HOURS
Knowledge of Job RATING SCALE
Accuracy in Essential Skills of Job Exceptional 4
Speed in Essential Skills of Job
Health
Good 3
Dependability
Initiative Fair 2
Adaptability
Cooperativeness
Resourcefulness
Poor 1
Judgment
Appearance
Would you rehire this employee?
Yes No
If no, state reasons
Comments:
Is a letter of resignation or statement attached?
Yes No
If not, explain why.
_______________________________________ ___________________
Head of Department Date