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Employee Clearance Form

This clearance form is used to process employee transfers, reassignments, or terminations. It requires the employee and supervisor to initial that equipment, property, financial obligations, and leave have been addressed. The employee provides their signature, mailing address, and separation date. Final pay or leave payout requires finance approval and submission of this completed form and termination request to HR. Supervisor, administrator, payroll, and records approval is also needed to authorize release of final compensation.

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Anne Beatrice Carimpong
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245 views1 page

Employee Clearance Form

This clearance form is used to process employee transfers, reassignments, or terminations. It requires the employee and supervisor to initial that equipment, property, financial obligations, and leave have been addressed. The employee provides their signature, mailing address, and separation date. Final pay or leave payout requires finance approval and submission of this completed form and termination request to HR. Supervisor, administrator, payroll, and records approval is also needed to authorize release of final compensation.

Uploaded by

Anne Beatrice Carimpong
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CLEARANCE FORM

Name ____________________________________ Last 4 SSN__________ EMPLID ____________

Position Code ________________ Position Title __________________________________________

Status: [ ] Transfer/Reassignment OR [ ] Termination

Transfer Effective Date ________________ Termination Effective Date ________________

By initialing below, I certify that I have complied with the Board Rules regarding the following items upon
separation.
Employee Supervisor

_______ _______ Equipment and property (computers, cell phones, iPads, uniforms, keys, etc.) returned

_______ _______ Procurement Card deactivated Financial Obligations – Check one


(Must be cleared for final check/leave
payout.)
_______ _______ Property accountability transferred

_______ _______ All leave entered & approved in Artemis Satisfied _______
(Approved for final pay)
_______ _______ Termination Request completed in PS
Not Satisfied _______
(Amount owed below)
Artist Series $_______
_____________________________ _____/_____/_____
Bad Debt $_______
Employee Signature Date
Registration $_______
Cell phone allowance $_______
______________________________________________
Mailing Address __________________________
Finance Approval
______________________________________________
City State Zip Code

The final paycheck and/or leave payout can be authorized for release to this employee upon the necessary
approval and receipt of the completed Termination Request in PS and Clearance Form by the Human
Resources Department.

ADMINISTRATIVE APPROVAL

Supervisor ___________________________________________________ Date _____/_____/_____

Supervising Administrator _______________________________________ Date _____/_____/_____

Payroll ______________________________________________________ Date _____/_____/_____

Records _____________________________________________________ Date _____/_____/_____


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