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Leaver Form - Hart District Council

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					HART DISTRICT COUNCIL - LEAVER FORM
To be completed by business unit staff in conjunction with the employee within a maximum of three working days from receipt of the employee’s termination notice. N.B. employees must always submit their resignation in writing Managers are reminded of the need to ensure all Council owned property is returned and should use the checklist attached to assist in leaving routines

Establishment: Employee Surname: Employee First Name: Personnel No.:

Hart District Council

If employee has more than one job/personnel number, please ensure that the personnel number for the job that they are leaving is entered above.

Last working day: Leaving date HDC: Is exit interview booked with HR? Reason for leaving code (see overleaf): If redundancy, amount due: Outstanding Claims/Loans, etc. Leave entitlement at leaving date: Leave taken to date: Leave to be taken before last working day: Leave for which payment to be taken in lieu: Overtime/Additional Hours claim to follow: Expenses claim to follow: Payment in lieu of notice: If YES, No. of weeks / months: Car Loan: Car Lease: Flexible working hours deficit: Relocation Exps:

e.g. dd/mm/yyyy e.g. dd/mm/yyyy

i.e. last working day before taking leave etc.

Yes/No

£

Days/Hours Days/Hours Days/Hours Days/Hours Yes / No Yes / No Yes / No

Check with Finance Department/HR that action to recover the following (as applicable) is being taken.

Yes / No Yes / No Yes / No Yes / No

Post Entry (Academic) Training: Enhancements (Golden Hello, Handcuffs etc): Other:

Yes / No Yes / No Yes / No

Will employee wish to repay or transfer to new employer? If YES state amount due:

Yes / No £

Updated: 13.05.09

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HART DISTRICT COUNCIL - LEAVER FORM
To be completed by business unit staff in conjunction with the employee within a maximum of three working days from receipt of the employee’s termination notice. N.B. employees must always submit their resignation in writing

Forwarding Address

Post Code Revised Bank/Building Society (if changed): Bank/Building Society Name: Sort Code: Account No. Reference: The Employee is reminded that failure to return Council-owned property/reimburse agreed financial commitments may result in a monetary penalty being levied and/or a debt being raised and pursued against you. Employee Signature: Date: ……………………………………. …………………….. …………………….. ……………………..

Authorised Signature: ……………………………………. Name: …………………………………….

Date: Contact No.:

Reason for Leaving Codes
(Please insert the appropriate code into the box on Page 1)

Reason for Leaving
End of Temporary contract Resignation – alternative employment Resignation – alternative local government authority Resignation – family commitment Resignation – following maternity leave Resignation – dissatisfaction Resignation – no reason given Dismissal – capability Dismissal – compulsory redundancy Dismissal – conduct Dismissal – unsatisfactory probationary period
Updated: 13.05.09

SAP Reason for Leaving Code
28 15 16 17 18 19 20 10 14 11 13 Dismissal – other Retirement – ill health Retirement – compulsory (at age 65) Retirement - voluntary VER – 85 year rule VER – efficiency Voluntary severance TUPE (transfer out) Death in service Moving away Full time education

SAP Code
12 22 23 24 25 26 27 29 09 33 34

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Leaver Form Management Checklist
Please tick or cross through boxes as appropriate This list is not exhaustive and is a guide only

Employee Name Post Title

Personnel No. Leaving Date

1. KEYS a) Safe d) Flexible Working Hours g) Other (please specify)   b) Internal Office Access e) Vehicles   c) Locker/Storage f) Fuel  

2. IDENTIFICATION/AUTHORISATION a) Identification Card c) Internal office access card e) Receipt/Bank paying in books g) Leisure Staff Membership Scheme card     b) Authorisation letters/cards d) Council stationery and cards f) Staff car park pass h) Other (please specify) ……………………………………. 3. EQUIPMENT a) Leased Car         

b) Check Council calculators, diaries, videos, books etc are returned c) Protective Clothing d) Tools e) Mobile Phone

f) Other (please specify)…………………………………………………………………………….

4. COMPUTING a) Ensure that appropriate action such as the changing of computer access is undertaken b) If the employee had a detailed knowledge of a system, Audit staff must be advised c) Other (please specify)…………………………………………………………………………….  

5. FINANCIAL Check with Finance Department/HR Team that action to recover the following (as applicable) is being taken. Will employee wish to repay or transfer to new employer? If YES state amount due £ a) Car loan (Finance) b) Car lease (Finance) c) Relocation (Finance) d) Flexible working hours deficit (Finance) e) Post Entry (Academic) Training (Finance) f) Other (please specify)      

……………………………………………………………. Manager/Supervisor
Updated: 13.05.09

……………… Date
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