Employee Offboarding Form

First Name

Last Name

Department

When is their last day?

Do they have a laptop?

Yes

Please bring the laptop to IT for maintenance before reprovisioning.

Do they have a cellphone?

Yes

Please bring the phone to IT for maintenance before reprovisioning.

Is this employee leaving a position that will be filled by someone else?

Yes

Please provide any available details as to who, when, etc.

Other notes / Comments

Employee submitting request.

First Name

Last Name

Phone