Employee Leaving Form

Employee Leaving Form – to be attached to employee’s leaving letter and returned to Human Resources

Surname ______/ Initials ______
Position ______/ Department ______
Leaving Date ______
Does this person have line management responsibility? / YES / NO
If yes, who will assume this responsibility? ______
Will this be a permanent arrangement? / YES / NO
Is this person transferring to another position in the University? / YES / NO
If yes, please give date of transfer ______
Annual Leave Days to be paid ______
(since commencement of current leave year)

If appropriate Human Resources will calculate any outstanding leave

Note: No payment can be made for accrued leave for fixed term appointments
For Manual Staff only: Accrued holiday pay (if any)______days
Reason for Leaving ______
Destination on Leaving (please circle appropriate option)
01 / Another Higher Education Institution in UK / 02 / Higher Education Institution in an overseas country
03 / Other Education Institution in UK / 04 / Other Education Institution in an overseas country
05 / Research Institution in the UK / 06 / Research Institution overseas
07 / Student in UK / 08 / Student in an overseas country
09 / NHS/General medical or general dental practice in UK / 10 / Health service in an overseas country
11 / Other public sector in UK / 12 / Private industry/commerce in UK
13 / Self-employed in UK / 14 / Other employment in UK
15 / Other employment in an overseas country / 21 / Not in regular employment
22 / Retirement / 31 / Death

Any Additional Comments

______

Forwarding Address

______

Please sign and return this form to Human Resources

Signed ______Date ______

Head of School/Department

January 2012