Staff Leaving Form

STAFF LEAVING FORM

Once you have completed your details on this form as appropriate in Section 1, please provide to your Head of School or Budget Centre to complete Section 2.

Section 1) To be completed by employee

Name:
Payroll No:
School/Dept:
Grade:
Reason for leaving:
i.e. Resignation/End of Fixed Term Contract/Retirement

Future employment - please tick one of the options below as appropriate:

Employment in another UK higher education institution / Employment in a higher education institution in an overseas country
Employment in another education institution in UK / Employment in another education institution in an overseas country
Research institution in the UK / Research institution overseas
Student in UK / Student in an overseas country
NHS/General medical or general dental practice in UK / Health service in an overseas country
Other public sector in UK / Private industry/commerce in UK
Self-employed in UK / Other employment in UK
Other employment in an overseas country / Not in regular employment
Retirement / Not known

Location after Leaving - please tick one of the options below:

England / Wales
Scotland / Northern Ireland
UK (not otherwise specified) / Other EU
Non EU / Not known
Prefer not to disclose

Forwarding address:

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Employee signature …………………………………….……………………………………..

Date……………………………………………………………………………………………

Section 2) To be completed by/on behalf of the Head of School/Budget Centre

Employee to be paid under his/her contract until / Appointment Expected End Date
Holiday Pay (days)*
Account to be Charged
Signed (Head of School/Budget Centre)
Date

Has the employee named in Section 1 returned any property that belongs to the University (for example, Lap-top/ ID Badge/ Keys)

¨ Yes

¨ No (Please confirm items that are outstanding

……………………………………………………………………………………………

*Please note by agreeing for holiday pay to be paid in lieu of leave not taken the Head of Budget Centre agrees to a payment over and above the salary due up to the end of employment

Please return this form to: Email: or to Aston Webb, B Block