EXIT CHECKLIST

Name:                                                                                       Date of Termination:                                       

Mailing Address:                                                                                                                                              

E-mail address:                                                                                                                                                

Social Security #:                                                                       Employee #:                                                   

             Medical/Vision/Dental Information & Cobra

             401(k) W/D, SPD, SMM and Tax Notice Information

             ESOP W/D, SPD, SMM and Tax Notice Information

             Cafeteria Plan

                                    Contributions to date                                                             

                                    Reimbursements to date                                                         

                                    Amount remaining                                                                 

             Hours to be paid on final PR:

                                    Actual Hours earned through

Termination date                                                                   

Accrued Vacation                                                                  

Less vacation hours taken, if any                                          

            Subtotal                                                                      

Total hours Due on Final Pay                                               

             Final Payroll Date:                                          

                                    Automatic Deposit:                                                                

Cafeteria Deduction:                                                             

             All Time sheets and expenses

             Return Keys

             Audit Bag

             Cellular Phone Termination

             Gym

             Mentor/ who do you mentor?

             Mentee/who’s your mentor?

             DO THEY HAVE UNBILLED WIP