Employee:______________________________________ Social Security # _________
Your employment with the Association has ended effective this date: _________ for the reasons checked below:
❏ Voluntary quit. Reason for resignation described below
❏ Job abandonment by employee
❏ Discharged for violation of workplace rules as described below
❏ Refusal to accept available work
❏ Restructuring - elimination of position.
❏ Layoff
❏ Other
Explanation:
Association Representative: ________________________ Date:__________
Employee Comments:
Employee signature:_____________________________ Date:__________