This form should be submitted to Human Resources immediately when intention to leave is notified. 
 			Letter of Resignation and annual leave card must also be forwarded along with this form	

Surname__________________________________________ 	          Forename ___________________________________________                	

Job Title___________________________________________           Federation ___________________________________________     

FT /PT Contracted Hours _____________________________

Reason for Leaving ___________________________________________________________________________________________
 (NB. Letter of resignation must be attached)

In the case of a termination due to the expiry of a fixed term contract, has the 3-step procedure has been followed:	Yes/No*
If not please contact Human Resources as soon as possible.							* Delete as appropriate

Last day of contract __________________________     Last day of service _______________________________________________
                                                                                             (paid to and inclusive of annual leave – see calculation below)	

For Human Resources Use only - check A/L calculation

ANNUAL LEAVE CALCULATION (in hours)

Annual leave carried forward		 _________________________

Current entitlement to date of leaving	+________________________

Total entitlement			=________________________

Annual leave taken			-________________________

TOTAL LEAVE DUE/OVERTAKEN		_________________________

Public Holiday adjustment	                _________________________

Is it your intention to recruit a replacement for this post		*Yes/No (delete as appropriate)
If yes, please refer to the vacancy requisition process

Signature of Manager/Head of Dept.__________________________________     Print Name______________________________     

Date____________________________ _______                    Contact Telephone No_______________________________________

Email______________________________________________________________________________________________________
	
FOR USE BY HUMAN RESOURCES DIRECTORATE ONLY	

Prepared by________________________     Authorised by___________________________    Date__________________________
	
FOR USE BY FINANCE AND PAYROLL ONLY	

Processed by: _____________________________________________________	Date: __________________________________________________