Sligo CIL Leaving Form HR 106

Sligo CIL Leaving Form HR 106

Sligo CIL Leaving Form – HR 106

This form is completed by employees who are leaving the Sligo CIL and not for employees who are moving within the Sligo CIL.

Section 1. To be completed by the employee
Surname: / First Name:
Position: / Personnel No (if applicable):
I hereby tender my resignation from the Sligo CIL and my last working day will be:
Effective Date / Last day of service
Date of Birth / PPS No.
Section 2. Reason for Leaving. Please () Tick one
End of Training / Suppression of Post
Family Reason / Dismissal (To be completed by the Line Manager)
Further Training/Education / Voluntary Redundancy
Going Abroad / End of Contract
Ill Health / Personal Reason(s)
Death* (To be completed by the Line Manager) / No Promotional Opportunities
No Job Satisfaction / Unsuitable Hours
Retirement / Other Reason(s)
If Other Reason(s) please specify:
NB! If reason(s) for leaving is retirement please complete Retirement HR Form 107 (a) in addition to this Form (HR 106)
Section 3. Pension Contributions
If you have chosen HIBERNIAN DIRECT as your PRSI provider and you have been or are paying into a PRSI Pension Scheme (All New Sligo CIL employees appointed from 23 November 2005) within the Sligo CIL please contact HIBERNIAN DIRECT to discuss your option(s).

If faxing please ensure Employee’s Name and Personnel Number are included on each of the form

Name ______Personnel No. (if applicable)______

HR 106_V2 MAR 2013 Page 1 of 3 Revised 05/03/2013

Section 4. Correspondence Address (for receipt of written communications from the Sligo CIL)
Street Address
Town/City
County / Country
Phone No: / Mobile Phone No:
Section 5. Bank Details
Please note that your final payment will be paid to the bank account held on record.
Bank Name / Bank Address
Bank Sort Code / Account Number
Payee Name:
Section 6. Employee Declaration
I declare that the above information is accurate and correct on the date indicated below. I authorize my employer to recover any monies owing by me from my final pay
Signature: / Date:
Section 7-10 To be completed by the Line Manager
Section 7. Objects on Loan (if applicable)
Please list Sligo CIL or Service User(s) property items on loan below. (e.g. Laptop, Mobile Phone, Keys, Travel Pass etc.)
Item(s) / Employee’s
Initials / Line Manager’s
Initial / Date of Return
Has/Have item(s) on loan been recovered Yes No
If No, please ensure that item(s) is/are recovered before the employee departs
Section 8. Leave Details
Please Note that any compensation payment for leave not taken during employment must be adjusted in Payroll in advance of leaving date
Leave Due to the Employee / Leave Entitlement (Hours) / Leave Taken
(Hours) / Hours Due
Annual Leave
Public Holidays

If faxing please ensure Employee’s Name and Personnel Number are included on each of the form

Name ______Personnel No. (if applicable)______

HR 106_V2 MAR 2013 Page 2 of 3 Revised 05/03/2013

Section 9. Recovery of monies owed by employee
Notify Payroll of any monies owing from the employee
Leave Due to the Employee / Leave Entitlement (Hours) / Leave Taken
(Hours) / Hours Due
Annual Leave
Public Holidays
Does the Employee owe monies for Revenue? / Yes No N.A.
Does the Employee owe monies for Payroll? / Yes No N.A.
Does the Employee owe monies for Training? / Yes No N.A.
Does the Employee owe monies for Service User? / Yes No N.A.
Section 10. Line Manager’s Declaration
  1. I confirm that I have notified Payroll in relation to the recovery of monies as outlined above
  2. I declare that the above information is accurate and correct

Dept: / Signature:
Name: / Date:
Tel No:
Local Payroll(Office Accounts Administrator)
Dept: / Signature:
Name: / Date:
System updated:
To be Completed by Board Of Director
Approved: / Signature:
Name: / Date:
Comments:
Circulation List
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If faxing please ensure Employee’s Name and Personnel Number are included on each of the form

Name ______Personnel No. (if applicable)______

HR 106_V2 MAR 2013 Page 3 of 3 Revised 05/03/2013

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