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Exit Forms

Please provide at least three (3) days notice to the SPH Personnel Office when separating, transferring out, or ending an appointment within the School of Public Health.

(Note: All links below open an Adobe PDF document in a new browser window. The latest Adobe Reader software can be downloaded for free.)

Form/Link Details
SPH Exit Checklist All employees. Please check out with your department and SPH Personnel.
Personal Data Form All employees. Please complete permanent address only.
Parking Payroll Deduction Cancellation Separation only. For employees enrolled in parking payroll deduction. This form is available in the SPH Personnel Office.
Unemployment Insurance Termination Report U5602 Separations only. To be completed by department.
COBRA Continuation Coverage (General)

2008 COBRA Mailing Address & Premium Information		 Separation only. For employees with health benefits. A complete COBRA application packet will be provided during exit/checkout with SPH Personnel.
Termination of Employment Benefits Checklist Separation only.

UC Account Distribution Guide

 Separation only.

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