Abraham Baldwin Agricultural College    
      EMPLOYEE SEPARATION CHECKLIST    
    Office of Human Resources    
This form should be completed by the department or division administrative assistant.
-As soon as date of termination is known: complete sections I and II, email the appropriate offices in section II, and prepare the PIF.
-By or before the last day of work: collect the items in section IV; complete section V; send the PIF,
this separation form, and the employee to Human Resources for an exit interview and
benefits counseling.
I          
Employee Name SS#
Mailing Address*
Street Address City State ZIP
* For mailing tax forms, W-2's, etc.
Phone numbers
Type of Separation Resignation Retirement Termination Transfer Other
                                                                     
II
Library materials returned/fines paid rpatel@abac.edu
Public Safety notified/fines paid dpyles@abac.edu
  Campus Post Office             rcarter@abac.edu                        
  Foundation               bbaldree@abac.edu                        
OITS dthompson@abac.edu
III Documents and Forms
Letter of resignation PIF
    (If applicable)                                                        
IV Equipment/Supplies Returned  
Keys  PDA Tools I have verified that this employee has vacated
his/her office and returned all items belonging to the department. 
  P Card   Laptop   Grade Books
Calling Card   Cell phone/Pager/Blackberry

Division/Department Head
ABAC ID Card Uniforms
                                                                     
V Final Check   Okay to release final check?
Send final check to home address Employee will pick up final check  Direct Deposit

Signature of person completing form

 Date
HR Use Only
Benefits Counseling: COBRA TRS or ORP Leave balances
Flex Spending Account
5/17/2006

Human Resources

 Date