UNT SUPERVISOR'S REPORT OF EMPLOYEE'S TERMINATION (UPO-6A)
Rev. 11/2002
Purpose: Procedure:
To obtain the supervisor's reason(s) for the employee's termination. The supervisor completes this form, signs it, and returns it with the final payroll authorization form to the Human Resources Department. Copies of this form may be made and given to the employee and for the department and supervisor's records. SOCIAL SECURITY NUMBER: DEPARTMENT: DATE REMOVED FROM PAYROLL:
EMPLOYEE'S NAME: JOB TITLE: LAST PHYSICAL DAY WORKED:
From the list below indicate the primary reason for the employee's termination:
Primary Reason Code:
VOLUNTARY - 100 Series
Enter School/Increase Hours...............................101 Accept Other Position.........................................102 Need More Hours of Work.................................103 Self-Employment................................................104 Marriage..............................................................105 Care for Family...................................................106 Be with Spouse....................................................107 Pregnancy............................................................108 Moving................................................................109 Military................................................................110 Ill Health..............................................................111 Inadequate Salary................................................112 Unhappy Here.....................................................113 Conflict with Supervisor.....................................114 Conflict with Co-Workers...................................115 Retirement -- Regular..........................................116 Retirement -- Early..............................................117 End of Modified Service.....................................118 Transfer to Another State Agency.......................119 Pending Disciplinary Action...............................120 Other -- Describe Below.....................................199
INVOLUNTARY -- Other than Discharge - 200 Series
Probationary Termination for Insufficient Performance, but No Disregard of Rules/ Misconduct………..……………………………201 Seasonal Layoff..................................................202 Lack of Funds - Layoff.......................................203 Lack of Work - Layoff........................................204 Unsatisfactory Performance, but No Disregard of Rules/Misconduct ..…………………………....205 Project Completed...............................................206 Ill Health/Injury...................................................207 Disability -- Retirement.......................................208 Retirement - UNT Rules.....................................209
Nepotism - UNT Rules.......................................210 Deceased.............................................................211 Other -- Describe Below.....................................299
DISCHARGE - 300 Series
Left without Notice.............................................301 Absenteeism/Tardiness.......................................302 Disregard for Fire, Health, & Safety Rules.........303 Destructive Activity............................................304 Disruptive Behavior............................................305 Insubordination -- Describe Below.....................306 Conflict/Refusal to Work with Supervisor..........307 Conflict/Refusal to Work with Co-Workers.......308 Alcohol/Drug Abuse...........................................309 Possession of Weapon, Narcotics, Alcohol.........310 Assault.................................................................311 Dishonesty...........................................................312 Theft/Misuse of Property......................…..........313 Falsification of Job Application..........................314 Willful Inefficiency or Work Carelessness.........315 Failure to Perform Duties/ Follow Instructions..316 Refusal to Work Needed Hours..........................317 Unsatisfactory Performance……………………318 Other Violation of Law, Rules, Standards -Describe Below.........................……………......399
Comments (attach additional sheets if necessary):
SUPERVISOR'S RECOMMENDATION REGARDING RE-EMPLOYMENT (Staff Members Only) Your recommendation is not necessarily a bar to any future employment for this person, however, should you answer "no", that information will be released with all future UNT applications.
WOULD YOU CONSIDER RE-EMPLOYING THIS PERSON IN YOUR DEPARTMENT?
Supervisor's Name (print): Supervisor's Signature:
For Human Resources Use Only:
Yes
No*
Maybe
*(If the answer is NO, you are REQUIRED to attach additional detailed documentation)
Title:
Date:
Phone:
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