END OF EMPLOYMENT HRIS 004

To meet auditing requirements please clearly complete all sections of this form.
Fax to Payroll (21812) when completed.

Section 1 EMPLOYEE DETAILS Section 2 SUPERVISOR TO COMPLETE

Employee ID (essential) FOR PROFESSIONAL, SECURITY, GROUNDS AND
DOCUMENT SERVICES STAFF ONLY:
Family Name
Would this employee normally avail himself or herself of
Given Names Accumulated Time Off at the end of the year?
TERMINATION DATE
(last day of work or leave)  Yes  No
Leave: In accordance with the applicable industrial instrument, I authorise If this employee is terminating prior to 30 April, are they entitled to
the University to deduct from my final pay, leave taken in advance of my payment for Accumulated Time Off not used at the end of last
entitlement. year?
I wish to advise I will be taking the following leave before finishing my
employment with the University (please submit a leave request to your  Yes  No If yes, days__________________
supervisor):

• To apply for Recreation Leave, Personal Leave, Special Leave with Pay,
Family Responsibility Leave, ERL please use myHR.
• Use a 008 Leave - All Staff form to make any changes to historical leave
bookings or to apply for Leave Without Pay, Maternity Leave and Long
Service Leave.
Section 2a SUPERVISOR SIGNATURE
Only complete if you do not have VC Delegation and support the
application
(If you do have VC delegation sign in Section 4 only)

SUPERVISOR’S SIGNATURE DATE

Leave Type:

days (if full time) or hr/min (if fractional) date

from to inclusive Section 3 HR COORDINATOR/OFFICER TO COMPLETE
CONFIRMATION OF
Comments: TERMINATION DATE -----------/-------------/-------------------
Resigned Voluntary redundancy
Retired Compulsory Redundancy
Dismissed Abandonment
Deceased Negotiated Separation
Exit interview: I would appreciate an exit interview with: ----------------------------------------------------------------
 End of Contract → Is severance payment due?
PVC HR Officer/Coordinator
Yes  If yes, weeks to pay ____________
Manager/Director of Unit Superannuation Officer No  If no, please explain why not: ____________

Head of School Supervisor

Other ___________________________

Payment Summary: Please send my Payment Summary to:

Street Comments:

Suburb

State Postcode

SECTION 4 AUTHORISATIONS –
Section 1a EMPLOYEE SIGNATURE IMPORTANT To meet auditing requirements, only forms with an
appropriate authorisation can be processed
I certify that all details above are correct and that I will acquit all my
Authorising Officer Name
University credit card transactions and that I will return all University
(acceptance of termination as
property prior to leaving.
per VC authorisation)
(please print your name)
EMPLOYEE’S SIGNATURE DATE
Authorising Officer Position
Contact No:
Authorising Officer Signature
UniSA Visa Card No: ______
Local HR Officer Signature

 Please ensure this form is returned to your local HR Officer Local HR Officer Name
ASAP or 2 weeks prior to your final day.
Local HR Officer Contact Ext:
Failure to return this form could result in final monies not being
paid in the first available pay
Date
 Please complete the exit checklist and return to your
supervisor on your final day