Personnel Action Form (PAF) - Terminations Only

To be completed by Administrator/Director -complete only sections that apply.

Section I- Employee Information

Name*
Director Name*

Section II- Termination/Resignation

Termination*
Employee was terminated by CICL
Resignation Without Notice*
(I. e. walk-out, No-call no-show)
Resignation With Notice*
(Plese submit copy of written resignation)
Retirement*
Effective Date*
Should be the date after the last worked, or paid time off day
Was Two-Week Notice Given?*
Did Employee Work the Entire Two Weeks?*
OK To Pay Out Accrued Vacation Time, If Any?*
If No, Please Explain Below
Eligible for Rehire?*

Section III- Signatures/Approvals

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Date
Benefit Impact Termination

Choices In Community Living, Inc.

HR Approval

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Date*

Fiscal Approval

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Date*
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