Termination Form

First Name*

Last Name*

Final day worked*

Days worked in current pay period*

Wages paid in advance*

Store account

Phone

Travel deduction

Travel reimbursement

Reason for separation*

If other selected above, please specify details*

Was the person a good worker?*

Did they take instructions well?*

Did they interact well with other staff?*

Were they easy to work with?*

Would you re-hire or recommend them to another manager?*

Additional comments on their employment?*

Your email