County Termination Form
CREEK COUNTY EMPLOYEES TERMINATIONS
NAME: ________________________________________________________________
SOCIAL SECURITY: _____________________________________________________
DATE TERMINATED: ____________________________________________________
REASON FOR TERMINATION: (Check One)
_____ Voluntary Termination of Employment/Resignation
_____ Involuntary Termination of Employment (i.e. Laid Off, Redundancy, Misconduct, Etc.)
_____ Involuntary Termination of Employment (Due to Gross Misconduct)
_____ FMLA Exhausted
_____ Leave of Absence/Workman's Comp
_____ Retiring
_____ Death
ACCUMULATED HOURS AS OF TERMINATION DATE
Sick Leave Hours: _____________________
Overtime Hours: _______________________
Vacation Hours: _______________________
Holiday Hours: ________________________
______________________________________________ _____
EMPLOYEE SIGNATURE DATE
______________________________________________ ______
HEAD OF OFFICE DATE