Resignation Notification Form

Employee Name:(Required)

Employee ID(Required)

Employee Email(Required)

Personal email is requested, to enable contact after separation.

Employee Business Title(Required)

Last Day To Work (Faculty Only: include last date worked and retirement date):(Required)

Employee may not use leave after the last day worked.

Department Name(Required)

Supervisor Name(Required)

Supervisor Email(Required)

Name of Idaho State Agency(Required)

Transfer Date(Required)

Do you have open protocols with any of the following committees (check all that apply)?(Required)

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