HR12

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Advice of Cessation of Employment

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This form is to be used to advise Human Resources of an employee resignation only in cases where the employee holds more than one continuing/fixed term position with the University, or when access to Self Service is not possible.
All other resignations should be submitted via Themis Staff Self Service.
This form is not to be used for the end of a fixed-term contract. / Once this form has been completed it must be signed, approved and sent to for processing prior to the relevant payroll deadlines.
Enquiries regarding this form can be made to your Local HR Contact: https://staff.unimelb.edu.au/human-resources/contact-hr
We encourage you to take the time to complete the University’s Exit Survey. The confidential information which you supply will assist us in evaluating and improving our employment practices. The survey is run by a third party, Corporate Leadership Council (CLC) and can be accessed via http://go.unimelb.edu.au/je9. Your feedback would be appreciated.
Section A: employee to complete

1. Employee Information

Employee No. / Organisation Unit Name
Family Name / Given Names
Forwarding Address (Residential Address for Payment Summary):
Street Address / Suburb
Country / State / Postcode

2. Cessation Date

If you are taking leave before resigning, enter the date as the last day of the leave period, not your last day of work.
Last day of employment

3. LEAVE

I apply to take / days of annual leave before my cessation date between:
and / inclusive
Or, my last annual leave was taken between: / and / inclusive

4. Employee approval

Signature of Employee / Date
Your final pay will be paid directly into your bank account on the next normal pay day.

privacy information

Information collected on this form will become part of your employment record. It will be stored securely and only used or released in accordance with the University’s privacy policy which is available from www.unimelb.edu.au/unisec/privacy.

Section B: organisation / department to complete

6. Reason for Cessation

If this is the end of a fixed-term contract please complete the HR22 form
Resignation Retirement Other, please specify:
Resignation or retirement letter is attached to this form
(this is required when resignation is due to resignation or retirement).

7. position information

Position No. / Do you wish to close this position? / Yes No
If the employee is leaving more than one position/assignment, a separate HR12 form must be completed for each position vacated.

8. approvals

Does this staff member have Themis HR supervisor responsibility? / Yes No
If yes, please complete Change Supervisor using Supervisor Self Service in Themis.
Signature of
Supervisor / Name
Date
Signature of
Head of Department
(Level 2 Delegation) / Name
Date
The staff member will lose University IT access at midnight on the date of cessation.
If the staff member requires access to University email beyond the cessation date, the supervisor must email at least 1 week prior to the cessation date. The request must include written approval by the Head of Budget Division and the period of the extension required. Up to 12 months access may be provided. https://policy.unimelb.edu.au/MPF1278
Continued access to any other systems may be addressed by completion of a HR39 IT Access form where appropriate.

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