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Resignation Request Form

Please complete the form below to submit a resignation request.
We will review the request and provide feedback regarding the recommended next steps.

* Indicates a required field
Company Name *
Employee Name *
Employee Email *
Manager / Supervisor Name *
Manager / Supervisor Email *
Date of Request *
Last Day of Employment *
Is the employee in any of the protected classes listed below? *
If Other, please provide description
When were you notified of the employee's resignation?
Was the employee's resignation submitted in writing? *
If Other, please provide description
Reason for Resignation *
(Please select all that apply.)
If Other, please provide description
Has the employee shared any complaints about the company? *
If Other, please provide description
Please include any additional information you would like to provide about this termination.
When you click “Submit,” you are confirming that you agree (1) information you submit will be protected and (2) used as permitted in our privacy policy and terms. If you do not agree to any of these terms, you may not submit this form.
Thank you! Your submission has been received!
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