Nyacor Management Company, Inc.
TERMINATION FORM Date: ___________ Shop: __________
EMPLOYEE NAME: ______________________________________ REASON FOR JOB SEPARATION: _____ Reduction of force due to lack of work (This employee will not be replaced.) _____ Voluntary Quit (Separation was initiated by employee.) a). What reason did the employee give for quitting? _________________ _______________________________________________________________________ b). Did the employee give advance notice for quitting? ___ Yes? ___ No? c). If yes date of notice? ____/____/____ _____ Discharge (Separation initiated by employer.) Discharge Date: ___/___/____ a). Reason for employee being discharged? _____________________________ _______________________________________________________________________ _______________________________________________________________________ b). Was employee given any warnings that his/her actions were in violation of policies, rules, standards, or expectations? _____ Yes? _____No? If so, give specific content and dates of any warnings unless in employee’s file at Corporate office. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ c). How was the company affected by this employee’s actions or behavior which caused the discharged? ________________________________________________________________________ ________________________________________________________________________
MANAGER SIGNATURE: ___________________________ DATE: ____________