Employee Termination or Change Form

Bolded fields are required

CONTACT INFORMATION
Company Name
Contact Name
Floor and/or Location
Department
Phone	EXT
E-mail
Service Tag (If Applicable)

CHANGE INFORMATION
Employee Name
What date is this effective on?	Select Date
Redistribution of old PC?	Yes No If YES, to whom?
Any personal data that needs saved?
Forwarding address for e-mails
Who needs access to personal or business files/folders?
Date file access and email forwarding will be disabled:
Additional Connected Devices (PDA’s, fax modems, etc.)
Notes: