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Termination Request Form

Please complete the form below to submit a termination 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
Why is the employee being terminated? What issues or incidents led to this decision?
Is this the 1st time you have discussed the issues or incidents with the employee? *
If Other, please provide description
What previous corrective actions have been taken? *
(Please select all that apply.)
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.
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