Employee Termination Form

EMPLOYEE TERMINATION FORM
This form must be signed by the Client Representative, dated and sent to G&A within 24 hours of termination.

As a reminder, employees working in CA, CO, CT, HI, IL, MA, MN, MO, MT, OR, UT, VT, and Washington, D.C, may have the right to receive their final pay at the time of termination or within 24 hours of their separation from employment. Some states such as IN, KS, ME, MN, MO, MT, NV, and WA, require employers to provide certain information if requested by a separated employee.

Medical premiums will continue to accrue if notifications of terminations are not submitted in the month in which the employee ceases to work for your organization. G&A Partners is unable to reverse premium charges for delayed termination reporting. Any portion of the premium for an employee's insurance coverage that is unable to be collected from final pay is the responsibility of the employer.

Please contact AccessHR (1-866-497-4222 or accesshr@gnapartners.com) with questions.
EMPLOYEE DETAILS
Company Name*
Employee Name*
Employee SSN (Last 4 digits)
Employee ID
Employee Address for W-2
TERMINATION DETAILS
Last Day Worked*

MonthDayYear
Date
Termination Date*

MonthDayYear
Date
YesNo
YesNo
Absenteeism and/or TardinessAlcohol/Drug Policy ViolationAssignment CompletedDeceasedFailed Employment ConditionsFailure to Return from LOAInsubordinationIntra-Company TransferJob AbandonmentLack of WorkMisconductNever Worked/StartedPhysical or Verbal AltercationProperty DamageResignationRetirementTheftUnsatisfactory Job PerformanceViolation of Company Policy
Please include additional/relevant details in the comments below, such as: dates employee missed work, name of the person who received the resignation notice, whether notice was verbal or written, reason for resignation, Company policies violated, etc. Please attach all relevant documents.
Please provide any supporting documentation.

Browse Files

Cancelof
Client Representative*
Date*

MonthDayYear
DateHourMinutesAM/PM Option
Certain jurisdictions also require company employees using a PEO to contact the PEO upon employment separation. If they were employed by a company engaged with G&A Partners as the PEO of record, and have been separated from employment, this is written notice that they must contact the G&A Partners at 1-866-497-4222 no later than the next business day from the date of their separation to report their separation and their availability for reassignment. They must initiate contact. Reassignment cannot be guaranteed, but eligibility for reassignment will depend on factors such as, but not limited to, reason for separation and skills, experience, and needs at the time of their separation. Failure to report could jeopardize their eligibility to collect unemployment benefits.
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EMPLOYEE TERMINATION FORM

EMPLOYEE DETAILS

TERMINATION DETAILS