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Employee Departure Clearance Form

Employee departure clearance form that must be completed by any full or part time non-student employee leaving the University of North Georgia. The form requires the employee to secure signatures and clearance from departments like Supervisor, Auxiliary Services, Purchasing, Facilities, Library, IT, Business Office and Human Resources to ensure there are no outstanding materials, obligations or access needs to be addressed. Failure to fully complete the form could result in delay of the final paycheck until proper clearance is obtained from all departments.

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Jery Tom
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136 views1 page

Employee Departure Clearance Form

Employee departure clearance form that must be completed by any full or part time non-student employee leaving the University of North Georgia. The form requires the employee to secure signatures and clearance from departments like Supervisor, Auxiliary Services, Purchasing, Facilities, Library, IT, Business Office and Human Resources to ensure there are no outstanding materials, obligations or access needs to be addressed. Failure to fully complete the form could result in delay of the final paycheck until proper clearance is obtained from all departments.

Uploaded by

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

EMPLOYEE DEPARTURE CLEARANCE FORM

Each full time and part time non student employee terminating employment with the University of North Georgia
must secure clearance from each of the departments listed below. Failure to complete this form in its entirety
could result in the terminating employee’s final paycheck being held until proper clearance has been
secured.

Name
Employee ID (900XXXXXX)
Last Day of Employment
Is Employee leaving or terminating
Department
Forwarding Address (If changing)
Personal Email Address
Phone
USG Transfer (If applicable)

Department Signature Date Description of Clearance


Supervisor/Dept. Head Outstanding Materials/Obligations
Auxiliary/Parking Services Outstanding Obligations
Purchasing Department P-Card Holder Y/N ---Please Select---
Facilities Keys ---Please Select---
Card Office Parking Permit/ID Card
Library Outstanding Materials/Obligations
Information Technology Network/Email Access
Business Office Outstanding Obligations
Human Resources Exit Interview Appointment

Termination Date for Insurance


Retirement Insurance Coverage Begins
Employee Signature
Date

*Terminating Employees pursuing the continuation of health insurance through COBRA will enroll online through their OneUSG
Connect Benefits Portal. You will use your ADP login information to access this portal.
*Retiring Employee: I certify this employment is severed as indicted and no agreement exists to allow the return to service, including
independent contracting. Any return during the calendar month of effective date of retirement shall render the severance invalid and
nullify the employee application for retirement.
*Faculty Members: Faculty members are expected to retain grade books (or their electronic equivalent) for a minimum of one year.
Grade books must be submitted to the departmental supervisor if the faculty member will no longer be actively employed by the
University.
*Note: Grade reports are owned by the institution, according to the office of Legal Affairs, Board of Regents
If you need this form in an additional format, please contact Michael McLeod: Michael.McLeod@ung.edu - (678) 717-2232

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