GROSSMONT-CUYAMACA COMMUNITY COLLEGE DISTRICT
NOTICE OF TERMINATION/RESIGNATION
ACADEMIC/NON-ACADEMIC PART-TIME EMPLOYEES
Site:
Cuyamaca
District
Grossmont
PLEASE PRINT CLEARLY IN BLACK INK OR TYPE (DO NOT USE PENCIL)
The following part-time employee has been terminated/resigned from their duties effective at the end of the working day,
,for the following reason (explain in detail):
Employee Name:
Last
First
Social Security Number:
Employee Category:
Middle
Phone:
Academic:
Adjunct
Substitute
Non-Classroom
Non-Credit Adult Ed
Community Service
Non-Academic Hourly:
Short term
Student
Work Study
Substitute
NANCE
Department:
Budget Number:
Supervisor/Mgr.:
Supervisor/Mgr. Signature
Employee Signature:
(If available)
Date:
Date:
Employee’s Permanent Address:
NOTE: If an employee continues employment with another department within the District, payment for hours of
employment will be paid on the regular payroll cycle.
Employees who are leaving all employment with the District and who have contributed to a retirement plan (PEAR,
PERS, STRS) during employment should contact the Payroll Department. If an employee leaving all employment with
the District wishes to have their final check mailed, they must provide the Payroll Department a stamped, selfaddressed envelope with a request to mail the check. The Payroll Department must be notified of any address changes
for W-2 distribution requirements.
Does your termination/resignation include all employment with the District?
Yes
No (e.g. continuing employment in another department within the District)
EMPLOYMENT SERVICES/PAYROLL OFFICE USE ONLY
Employment Services Review
Payroll Review
EMPMSTR
PAYASSIGN
BENEINFO
(Distribution: Original: Payroll/Employment Services; Copy: Department; Copy: Employee)
97-0472-001D rev. 5/14/97/bg
EMPLY
EMPOS
TIMESHEET
MANDTAX
RETPLAN
RETFORM
BDEMP