Computer Science Department

EXIT CHECKLIST DEPARTMENT OF COMPUTER SCIENCE AND ENGINEERING

Instructions: This checklist must be completed for all budgeted and wage employees not returning to work. If an employee does not return from a temporary absence, the supervisor must complete this form within one week of the employee’s expected return date. The supervisor must indicate N/A for any items not applicable to the employee.

Employee name: ______

Social security number: ______Title: ______

Supervisor name: ______

Last day of work: ______Last day of employment: ______

Human Resources—Payroll 17. (______) Allow account to stay 1. (_____) Letter of resignation from open until ______employee or written verification from supervisor indicating end of Supervisor employment. (_____) Checked out training (_____) Coordinate with Payroll as to 18. 2. resources returned how final check will be picked- up/mailed 19. (_____) Bank of America Corporate Card destroyed if leaving the (_____) COBRA 3. University 4. (_____) TRS 20. (_____) Work area cleared 5. (_____) Sick Leave Pool Form 21. (_____) FAMIS, SIMS, Epik Access 6. (_____) Forwarding address for W-2 Cancelled 7. (_____) Outstanding payroll advance 22. (_____) Electronic Dissertation 8. (_____) Outstanding travel advances 23. (_____) Exit Interview Questionnaire 9. (_____) Vacation Leave Balance(hrs) 10. (circle one) Lump Sum payment OR Facilities Remain on payroll to exhaust hours? 24. (_____) Keys returned/Key code removed Administrative Services 25. (_____) Laptops/projectors returned 11. (_____) Parking processed 12. (_____) Mailbox 26. (_____) Home equipment and 13. (_____) Graduate Faculty software turned in membership status revised 27. (_____) Pager, cell phone, voicemail, deactivation

CSG 28. (_____) Equipment in office verified 14. (_____) Verify with CSG that all by both CSG and Employee computer account allocations are ______cancelled (CSG Initials) (Employee Initials) 15. (_____) Security Access 16. (_____) Employee has received a Advising disk/CD with all computer files 29. (_____) Graduate Advisor ______(must be initialed by employee) Final acknowledgement: I certify that the proper authorities have completed all steps in this checklist.

Employee signature: ______Date: ______(Required if available)

Supervisor signature: ______Date: ______(Required) Return completed Exit Checklist to 319A TEAGUE on the employee’s last working day with CSE.