Separation of Employment

Name of Employee Separating from Your Department *Enter formal name as listed in SAP.

Department *

Separating Employee's Web ID *

Separating Employee's SAP Personnel Number

Date of Separation *

Name of Supervisor *

Is the employee leaving the University *

Yes, the employee will no longer be an employee of the University.No, the employee is transferring to another department on campus.

Is the employee transferring to another state agency, junior college, or university within the state of Mississippi? *

YesNo

If transferring to another state agency, junior college, or university within the state of Mississippi, please provide name of the agency *

Is the employee retiring from the University? *

YesNo

Signature Authority *

Is the employee listed as a signature authority on any accounts?YesNo

ORSP Notification *

Is the employee a PI/PD on a current grant? (ORSP to be notified)YesNo

Does the employee have SAP Access? *

YesNo

If the employee has SAP Access, please provide instructions for sap@olemiss.edu

Does the employee have E-Form Access? *

If the employee has E-form access, the access will be removed effective the date of separation.YesNo

Exit Checklist Required *

I am aware that an Exit Checklist is required and will be completed no later than the employee's last day of employment within my department.Yes

Acknowledgement Along with submitting this notification, I acknowledge that I am aware that this notification will be delivered to various entities in order to assure access and/or privileges provided to the listed employee by my department will be removed on the effective date of the separation. I am aware an E-Form 3 provides the official notification to Human Resources that the employee is separating from employment within our department. Upon receipt, the Benefits team will provide benefit-related details to the employee for employees separating from employment from the University.

Name of individual submitting the form, if not the supervisor

Please ensure that the department processes the E-Form 3 timely.

Details for Separation Notification

Verification