Employee Name:	Unit:	Date Initiated:
Supervisor Name:	Scheduled Last Work Date:
Unit Clearance for Employee Exit:
Supervisor will check which units the employee must be cleared by prior to their last day of employment: (Check Appropriate Boxes)
UNIT	NAME	SIGNATURE	DATE
GENERAL SERVICES:
Security Card
Master Key
Building Keys
Vehicle Turned in
Numbered Inventory
Non-Numbered Inventory
Uniforms
eVa Account Deactivated
Employee ID Card
PPE
INFORMATION TECHNOLOGY:
Removal of Data
Email Account
TELECOMMUNICATIONS:
Telephone Credit Card
Handheld Radios
Mobile Radios
Cell Phones
Pagers
HUMAN RESOURCES:
Exit Interview
FISCAL:
Corporate Charge Card
Travel Charge Card
Receipt Book
Outstanding Travel Advances
Agency & State Systems Access Removed
RESOURCE PROTECTION:
Badge
Forest Warden Decommissioned
OTHER:
REMARKS:
EMPLOYEE EXIT COMPLETED:
SUPERVISOR SIGNATURE	DATE