END OF EMPLOYMENT CHECKOUT FORM

Full-time Faculty, Administrative and Staff Personnel

BrighamYoungUniversity - Hawaii

Name: BYUH ID #

Termination Date (Fac / Admin / Staff): Check Date (Fac / Admin / Staff):

___ Deposit my final check as usual, or ___ I will pick up my final check, or ___Mail my final check to my forwarding address as listed: (Address:______Phone#:______)

___ Mail my W-2 to my mailing address listed on the People Soft self service.

STEP 1: DEPARTMENT: Your Department should complete all items in Step 1 with you.

___ SecureUniversity / Department property (e.g., cell phones, lap tops, PDA’s, pagers, uniforms, books, etc.).Department will contact Materials Management Office to inform them if the department will return the cell phone or use it for another employee.

___ Collect and verify all BYU-H keys, properly transfer or return them to the appropriate key office (BYU-HFacilities Management).

___ Change computer passwords/access codes/telephone/email.

DEPARTMENT NAME / SCHOOL:

DEPARTMENT CLEARANCE: ______/______/______

(Authorized Signature) (Date) (Phone)

STEP 2: EXIT INTERVIEW: Fill out exit interview form online at

STEP 3: CAMPUS SERVICES: The HRS Office will notify the following offices of your termination. Please resolve all matters with these departments before you visit the HRS Office. All items must be resolved to finalize your checkout from the University and to initiate the processing of your final check(s). Have each department listed initial for clearance.

___ LibraryReturn all library books and materials and pay any fines.

___ Travel Services Return travel corporate card/clear outstanding travel balances

___ Employee Accounts Receivable Resolve any outstanding employee accounts (e.g., computer loan,employee loan, utility bills for faculty, etc).

___ HealthCenter Resolve any outstanding medical bills, etc.

___ Post OfficeUpdate mailing address/return mailbox key, if applicable

___ SecurityResolve any outstanding parking tickets, etc.

___ Material ManagementReturn purchasing card/personal cell phone on BYUH plan

___EISTerminate access to BYUH systems

___ Student Activities- retirees onlyObtain new retiree ID card.

I have cleared all encumbrances, returned University property and paid all obligations to my knowledge.

PERSON TERMINATING EMPLOYMENT: ______/______

(Signature) (Date)

STEP 4: HR OFFICE: Go to the HRS Office for a discussion of post-termination benefits and to finalize your checkout from the University.

___Return PCC discount card___ Return BYUH ID card____REMF (retirees)

___ Flexible Spending Account (FSA)___ Update addresses ____DMBA premiums- current?

___Retirement information____Vacation hours payout (____hours as of _____)

HRS OFFICE CLEARANCE: ______/______ (Authorized Signature) (Date)