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					                    Employee Leaving                          HR Shared
                                                              Service Centre
                                                                                       1st Floor,
                                                                                       Wat Tyler House, West

                    Notice                                                             Beckhampton Street
                                                                                       Swindon, SN1 2JG
                                                                                       Tel: 0800 232 1103
                    (ELN 1)                                                            Fax: 01793 610202
                                                                                       E-mail: Harthr@capita.co.uk



This form must be completed when an employee submits their notice of resignation or when an employee is given
notice to terminate their employment.
If an employee is leaving multiple positions, please complete a separate form for each individual position.
Should you have any queries regarding the completion of this form, please contact HR First Response on 0800 232
1103, or e-mail Harthr@capita.co.uk.
*Mandatory Field (Form cannot be actioned without this information)

                                                  (Office Use Only)
Confirmed Leave Date                                             Reason for Leaving

Employee No.*                                                           Title* Mr, Mrs, Miss etc*
Surname*
Forename(s)*
Job Title*
Service Area*
Is this employee a Line Manager?*                                       Yes         No
If, YES, please provide the name of person taking over the
leaver’s line management.
Please note: if there is more than one person taking over line management responsibilities, please complete a Line
Manager Change Request form (LMC1) and forward to HR First Response.
 (Office Only)                    Copy of the form passed to BA to amend reporting lines (If applicable)

Leavers Information
Employee’s Last Day of Paid                               Employee’s Last
Service*                                                  Working Day
Annual Leave Accrued to Last Day of Service (Hours / Days)*
Annual Leave Taken to Last Day of Service (Hours / Days)*
Annual Leave to be Reclaimed (Hours / Days)
Annual Leave to be Paid (Hours / Days)             (3550)
                                                   Taxable                           Non-Taxable
Termination Payment (if applicable)                             £                                          £
                                                   (6562)                            (6560)
                                  Yes                   Taxable (6170)                 Non-Taxable (4085)
Payment In Lieu of Notice
(PILON)                           Date from                                      Date to
                                  No
Forwarding Address                                                      Effective Date




ELN1 - Version 3.0 (November 2010)                Last printed 30/09/2012 12:52:00                             1 of 3
Reason for Leaving - Please select appropriate box
Compromise Agreement                                 Overload of Work
Died in Service                                      Premature Retirement Benefit
Discrimination                                       Problems with Work Colleagues
Dismissal                                            Problems with Manager
Dissatisfaction with Working Environment             Promotion
Emigrating                                           Redeployment
End of Fixed Term Contract (FTC)                     Redundancy - Compulsory
End of Maternity Cover                               Redundancy - Voluntary
End of Secondment                                    Relocation
End of Temporary Contract                            Requisition Appointment
End of Training                                      Resignation
Financial Reasons                                    Resignation - Ill Health
Further Education                                    Resignation - Personal Reasons
Harassment and/or Bullying                           Retirement - Normal
Hours not Suitable                                   Retirement - Flexible
Job Dissatisfaction                                  Retirement - Early / Premature
Lack of Capability                                                                    Tier 1
Lack of Job Security                                 Retirement - Ill Health          Tier 2
Lack of Training/Career Development                                                   Tier 3
Maternity / Paternity / Family Reasons               Retirement - Redundancy
Misconduct                                           Terminate due to Health Capability
Need for Change of Job/Career                        TUPE Transfer
Need for New Professional Challenge                  Travel Problems / Work Closer to Home
New Employment                                       Unable to Balance Work & Home Life
Non-Starter                                          Unsuitable / Insufficient Equipment
Not Enough Work                                      Will no longer be working
Not Known                                            Other Reason (Please specify)

Not Returning from Maternity Leave


Authorised Signatory*                                Signature*

Contact No.*                                         Date

Employee Signature                                   Date


     Once completed and signed, this form must be sent to the HR Service Centre along with
     the Resignation Letter and any other relevant documentation.



  ELN1 - Version 3.0 (November 2010)       Last printed 30/09/2012 12:52:00                    2 of 3
Manager’s Checklist
Employee’s notice received in writing                                                            N/a        Yes
Employee Leaving Notice (ELN1) form completed by Manager, signed and sent to Hart Hr
                                                                                                 N/a        Yes
– HartHR@Capita.co.uk (check annual leave)
Parking Permit cancelled and returned                                                            N/a        Yes
Employee ID and Swipe Card returned (2x different cards)                                         N/a        Yes
HART equipment returned
e.g. Laptops, Phones, Uniform, CIS Tokens, Internet Banking USB Card Reader, Car,                N/a        Yes
Saveword token etc..)
Has the employee got any outstanding training costs to be reclaimed?                             N/a        Yes
Employee removed from Central Register (phone & contact details)                                 N/a        Yes
Has the Employee got a 365 card? Inform Leisure                                                  N/a        Yes
IT Systems
Uniform                   Abritas             EAnalyser                         GCSX Accounts
EFinancials               Parking             Paris                             Covalent
Anite@work                IBS                 Northgate Land Charges            Eros
Gladstone                 GIS                 Network Account                   Lagan
                                                                Nominated Replacement (ISS / EProc)
Lotus Notes               EProc               ISS

                                                  Office Use Only
Actioned By (HR)                                                               Date
Pension forms sent to Employee
                                                       Position (and Post if applicable) ended
(if appropriate)
Is the employee over 65?                               Hampshire Pensions Notified
Exit Interview                                         Relocation Expenses
Training Fees                                          Car Loan Administrator Advised
Estimate of Pension, Compensation & Redundancy Payments (Redundancy Only)
                                                       Input By                                  Date
Date Received (Payroll)
                                                       Checked By                                Date
Car Scheme Closed                                      Court Order – Court Notified
Pension forms issued to Wiltshire Pensions             Pension forms sent to Employee (if appropriate)
P45 issued                                             Student Loan – Details on P45
NI Reduced Liability Card Returned                     Overpayment Invoice Produced
Overpayment Letter Sent                                Maternity Pay Recovered
Childcare Vouchers
Notes (e.g. Redundancy Calculations)




ELN1 - Version 3.0 (November 2010)                Last printed 30/09/2012 12:52:00                       3 of 3

				
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