Student Worker Exit Date

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Student Worker Exit Date Form

This form is to be completed by the supervisor, department chair, director, or assigned designee prior to an employee’s departure from OPSU. The supervisor must provide this form to the OPSU HR Department.

Employee:(Required)

ID #:(Required)

Position #:(Required)

Department:(Required)

Termination Date:(Required)

Please indicate below the status of this student employee:(Required)

Graduated or Transferring

Not Returning to Position

Supervisor Name:(Required)

Date(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

**Please have student provide forwarding address for payroll and tax purposes. (Final paychecks and/or W2 information will be sent to this address.)**

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