ࡱ> mola %bjbjjj A`?b?b  bbbbbvvv8ZDvO: AOCOCOCOCOCOCO$QrTgObgObb|O"""RbbAO"AO""FiMK@CI6-OO0OyI*U*UHMKMK8*UbK"")_gOgOO*U B (: SEPARATION/TERMINATION CHECKLIST PROCEDURES This checklist should be initiated only by the home department and upon receipt of a written notice of resignation or termination. The following procedures must be completed for all separating/terminating employees except students, grads and temporary hourly employees. NOTE - for student employees, grads, and temporary employees. An email should be sent to  HYPERLINK "mailto:termchecklist@listserv.montana.edu" termchecklist@listserv.montana.edu with the information itemized below in Section I and Section II-a). If special instructions are required for their employee mailbox, please note the instructions in the e-mail. If employee is transferring to another department on campus, it is still necessary to complete all sections on this form, except Section III-a). It is not necessary to meet with Human Resources regarding insurance, etc. if the employee is remaining on campus. I EMPLOYEE INFORMATION (to be completed by home department) Name: _____________________ _______ Name: ___________________________________ Todays Date: ____________________________ Last 4 digits Banner ID# (i.e. xxx1111): ________________(For security purposes, please DO NOT use SSN) Date of Separation/Termination: _________________ Employing Department: ___________________________________________ Please check if the employee is transferring to another department on campus with a break in service of less than 5 working days ( II EMPLOYING DEPARTMENT RESPONSIBILITIES: a) Acknowledgement of receipt of written notice of resignation or termination: On _____/_____/_____ I received from the employee listed above a written letter of resignation or notice of termination that specifies an effective date of _____/_____/_____. A copy of the notice of resignation or termination will be sent to Human Resources and an Electronic Personnel Action Form (EPAF) submitted. ____________________________________________ ___________ ______ Department Representative Signature Date b) Please send an e-mail to termchecklist@listserv.montana.edu and include the information from Section I above Name, Department, last 4 digits of their Banner ID#, Date of Separation/Termination, and note if the employee is transferring to another department on campus. For privacy reasons, please do not include the employees reason for leaving in the e-mail. c) Process an Electronic Personnel Action Form (EPAF) using the effective date of separation. A copy of the notice of resignation or termination should be sent to Human Resources. Provide this checklist to the employee to complete the Employee Responsibilities listed below in the Section III. III EMPLOYEE RESPONSIBILITIES All separating employees must submit a written notice of resignation or termination that includes an effective date to his/her immediate supervisor and copy the appropriate department representative responsible for processing Electronic Personnel Action Forms. This Separation/Termination Checklist must be initiated and signed by a representative of the home department who can attest to having received a written notice of resignation or termination. Additionally, all separating employees must obtain signatures from the Facilities Services, University Police, University Business Services, and Human Resources regarding the following items: University Police, Huffman Building All traffic fines must be paid before you separate from the University. This signature verifies that you have paid all traffic fines. ______________________________________________________ ________________________ University Police Representative Date (For University Police Use Only) Parking Due $_________________________________ ____________________________ Initials Facilities Services, Plew Building (6th Ave. and Grant St.) All keys issued to you must be returned to Facilities Services. This signature verifies that no keys remain checked out under your name. You understand that failure to return keys upon termination of your employment at MSU may result in their being considered stolen property and being reported to the proper authorities. Please see  HYPERLINK "http://www.facilities.montana.edu/fs/admin/key_requests.html" http://www.facilities.montana.edu/fs/admin/key_requests.html for key return hours. ______________________________________________________ ________________________________ Facilities Services Representative Date University Business Services, Montana Hall The University Business Services located in Room 103 Montana Hall will check you out of the following areas: Student Accounts___________________________ P Card__________________________ Loan Service Center_________________________ Travel__________________________ _________________________________________ _______________________________ University Business Services Officer Date University Human Resources (920 Technology Blvd. Suite A) Please visit Human Resources at 920 Technology Blvd. Suite A to meet with a Benefit Associate to review your termination checklist. If you are unable to visit us at our physical location please call University Human Resources at 994-3651 and we can schedule a time in which a Benefit Associate can meet with you. University Human Resources is required by State Law to explain employees options to continue health insurance coverage through the COBRA plan. I have been advised of my options to continue health insurance coverage through the COBRA plan. ____________________________________________________________________________________ Employee Signature Date ____________________________________________________________________________________ University Human Resources Date I participate in the Optional Reimbursement Account: ( I give University Human Resources permission to deduct the remaining balance of my yearly election from my last paycheck: ( Employee Signature Date University Human Resources will also provide the information you need regarding: ( Direct Deposit ( Retirement ( Final Check Distribution ( Obtaining forwarding address for W2 Life Insurance ( Final pay of annual leave and/or sick leave Do you consider your leaving MSU as retirement? ( Yes ( No The COMPLETED checklist must be returned to the home department on or before the final day of work. The home department must submit the letter of resignation or notice of termination to Human Resources once the Electronic Personnel Action Form (EPAF) has been created. (((( REMINDERS (((( Did you remember to empty your intramural locker, return library books, return phone cards, and pay any outstanding personal charges including CatCard? In special circumstances, ITC can temporarily forward your campus email to another account. To request email forwarding, contact the ITC Help Desk at 994-1777. MSU Retiree Association:  HYPERLINK "http://www.montana.edu/retired/" http://www.montana.edu/retired/        "+,-̺sbP? hh:CJOJQJ^JaJ#hrAhCJOJQJ\^JaJ hh CJOJQJ^JaJ hh'CJOJQJ^JaJ#hh[CJOJQJ\^JaJ#hhzCJOJQJ\^JaJ#hh:CJOJQJ\^JaJ#hh. >*CJOJQJ^JaJh:>*CJOJQJ^JaJ#hh7z>*CJOJQJ^JaJ#hh:>*CJOJQJ^JaJ,-? }$ 0]0^a$ $ 0]0a$$ 0]0^`a$$ ]^a$gd $ a$gd$ ^a$gd $ a$gd$ a$  ^   < > ? 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