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| Exit Packet |
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| Employee Name |
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Termination Date |
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| Reason for Termination: |
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| Items Returned: |
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| Key |
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| Security Card |
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| Password for computer |
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| Password for voice mail |
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| Items Received: |
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| Health Insurance Mini-Cobra/Termination |
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| Cafeteria Plan Documents |
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| 401k PlanDocuments |
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Your option/keep in $50 fee per |
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year administrative to [Firm Name] |
| Disability insurance date of term |
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| Please initial and sign |
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| Employee Signature |
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Date |
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| Employer Signature |
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Date |
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