MIT Department of Biology: Termination Form

Termination Form

Request to Process an Appointment Termination, Cancellation, Transfer, Resignation or Retirement.

This is an internal form for use of the Department of Biology only.

Questions or comments regarding this form or its appropriate use may be directed to Fran Chaput, fchaput [at] mit.edu, x8-7422.

Terminating employees must turn in keys and Building 68 access cards to Biology Headquarters, 68-132.

*required fields

Termination Form

Title
Last Name*
First Name*
Middle Name
Social Security Number
Forwarding Address (if none known, please type "unknown")*
Position	Other:
Effective date of termination*	Last day worked if different
Number of Vacation Days Due
Employee status on termination*
New employer if known

Reason for termination (select main reason for leaving)
Voluntary
Other Voluntary Reason
Involuntary
Other Involuntary Reason
Discharge
Other Discharge
Comments on reason selected

Employee Evaluation by Supervisor
Supervisor*
Supervisor phone
Description of present duties
Performance and ability
Would you recommend for reemployment?	yes no

Your Information
Your Name*
Your Email* (a copy of this request will be sent to this address)