New Employee Checklist - Download as DOC

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					                                                        DEPARTMENT OF MEDICINE                                        Instructions
                                                         Employee Exit Checklist

 This checklist assists the employees and Section Administrators in the termination process. It should be completed prior
 to employee's last day of work.

 Employee Name:                                                            Employee UIN:
 Employee Last Working day:                                                Effective Termination date:
 Job Title:                                                                Mail Code:
 Building Name/Address:                                                    Supervisor Name / Ext. :



 Employee Responsibility                                                          Section Administrator Responsibility
     Submit resignation letter, if appropriate                                       Collect building keys / access card
     Submit green sheets with final vacation/sick leave usage                        Collect office supplies, equipment, credit card, P-card
     Contact State University Retirement System 1-800-275-7877                       Terminate voicemail / E-mail message
     Access NESSIE: update W-4 form, address and phone number                        Terminate EPAF authorization, if applicable
     (final W-2)                                                                     Terminate employee access to computer systems
     Give contact information to Benefits                                            Provide IDES brochure or online link
     Return University I-Card to Photo ID Office at 1790 SSB /241 CIU                Send signed Departure form to DOM HR
     Cancel parking/transit allotment                                                Forward this form to DOM HR
     Tuition Waiver                                                               Department Responsibility
     UIC Library fees / books returned                                               PHYSICIANS ONLY: Y' payment?
     Turn in keys/access card                                                        Submit PITR to end job within 5 days of end date
     Change password on voicemail to 1234567                                         Obtain final green sheet(s) and calculate payout
     Turn in lab coats                                                               Update PEALEAV after final calc date for final sick and vacation
     Turn in pagers and/or University cell phones                                     balances
     Turn in laptop and/or other University computer equipment                       Generate DART
     Clean out desk/locker                                                           Process adjustment if applicable
     Submit any outstanding Medical Care Assistance Plan (MCAP)                      Submit adjustment via Workflow
     and/or Dependent Care Assistance Plan (DCAP) claims to Fringe                   Fax Departure Form to OIS if applicable
     Benefit Mgmt.                                                                   Fax completed Employee Exit Checklist to Benefits Office at:
     FOREIGN NATIONALS ONLY: Sign Departure Form                                     312/996-5733.
 FOR PHYSICIANS ONLY                                                              Benefits Office Responsibility
    Resigning from Medical Staff Services (letter must indicate)                     Notify CMS if employee is transferring to another State of
    All patient charges submitted                                                    Illinois organization
 Check the box for benefit items that apply to you:                                  Advise of COBRA for Health and Dental Insurance
     I am transferring to another State of Illinois organization                     Advise of portability for Reliastar Term Life Insurance.
     I have Health and/or Dental Insurance                                           Advise of portability for Long-Term Disability
     I have Reliastar Term Life Insurance                                            Advise of 30-day portability for Life Insurance.
     I have Long-Term Disability insurance                                           Advise of options for 403B Savings Plan
     I have Life Insurance                                                           Advise of options for 457 Savings Plan
     I contribute to a 403B Savings Plan
     I contribute to a 457 Savings Plan


Employee Signature:                                                       Section Administrator Signature:
                                                                   Date                                                                           Date

Medicine HR Signature:                                                           Benefits Office Signature:
                                                                   Date                                                                           Date


                                                                                                                                        Revised 4/2005

				
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