"*" indicates required fields Store Location*- Select Location -Smyrna, GAAtlanta, GAJonesboro, GACollege Park, GAFairburn, GARiverdale, GAPonce de Leon, GANorman West, OKMoore, OKWarr Acres, OKReno, OKStillwater, OKRockwell, OKYukon, OKMidwest City, OKMustang, OKManager's Email* Employee Name* First Last Last Day Worked* MM slash DD slash YYYY Supervisor's Name* First Last Is re-employment recommended?* Yes No If no, reason:Is individual transferring to another store?* Yes No If yes, what location:Reason for Termination* Voluntary Termination (An SJAC Exit Survey should be given to all voluntary terminating employees) Involuntary Termination List previous warnings and dates.*What incident occurred on the final day of work that led to decision to terminate? Release during Probationary Period Chronic absenteeism or tardiness or performance. Unsatisfactory Performance End of Seasonal/Temporary Work Reduction in Force Other Immediate Supervisor*Date* MM slash DD slash YYYY Human Resource Approval*Date* MM slash DD slash YYYY
