» Independence – User Separation Request

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This form is intended for administrators to notify us of an employee termination.

Terminated Employee's Name:*
First Last
What date will the employee be terminated?*
Should we archive/back up their data?*
- Email
- User Documents
- Other
Additional Info:
Your Name:*
First Last
What's the best way to contact you?
- Cell Phone #
- Office Phone #
- Email
- Other
Cell Phone #:*
Office Phone #:*
How should we contact you?*
Email
This field is for validation purposes and should be left unchanged.

This form is intended for administrators to notify us of an employee termination.

You have been automatically directed to the Employee Separation form per your request.
Terminated Employee's Name:*
First Last
Terminated Employee's Email:*
Enter Email Confirm Email
What date will the employee be terminated?*
Should we archive/back up their data?*
- Email
- User Documents
- Other
Additional Info:
Your Name:*
First Last
Your Email:*
Enter Email Confirm Email
What's the best way to contact you?
- Cell Phone #
- Office Phone #
- Email
- Other
Cell Phone #:*
Office Phone #:*
How should we contact you?*
Email
This field is for validation purposes and should be left unchanged.

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