ࡱ> { bjbjzz 8G3 ,4n "3333333$0683'''3|4~-~-~-'3~-'3~-~-2 30!?0)2m34042:9)9, 39 3du#i$~-%%{u#u#u#33,u#u#u#4''''9u#u#u#u#u#u#u#u#u# : CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS Faculty and Staff Separation/Clearance Process Who needs to complete THE SEPARATION/clearance process? All faculty and staff who are separating employment from CI must complete the separation/clearance process. Full and Part-time Faculty members who are expected to return during the following semester may be exempt from this process, at the discretion of the President or Department Designee. The Department Designee should complete the clearance process (Sections A, B and C) for an employee who is separating (i.e. resignation, end of temporary appointment, dismissal, layoff, death). Exceptions may include short-term leaves and sabbaticals, at the discretion of the Department Administrator. Department/Office RESPONSIBILITY: Each department should have at least one designee (and one back-up designee) who is responsible for clearing all faculty and staff. Department Designee signatures must be on file in Human Resources Programs to be valid. Contact Human Resources Programs by phone (ext.8490), immediately upon notification of a pending employee separation for any reason. When the separation is the result of disciplinary action, the Separation Clearance Form must be completed by the department designee and returned to Payroll no later than 3 business days prior to the actual separation. Section A Employee Data CI ID #: This is the PeopleSoft HR system-assigned, CI ID number that is a unique identifier for employees in the HR database. Last Day Physically Worked: List the last day (close of business) that the employee actually worked. First Day of Separation Status: List the first day (beginning of business) that the employee will be separated from the University. First Day of Retirement Status: List the first day (beginning of business) that the employee will be retired from the University. In addition to the Separation Clearance Form, a letter of resignation may be obtained from all faculty or staff who are resigning or retiring. (Not applicable for separations of temporary employees with appointment expiration dates.) Copies of these documents should be forwarded with the attached Faculty and Staff Separation/Clearance Form to Human Resources Programs, Administration Building Room 1613 ext.8490. Department/Program Name: Name of Department or Program in which the employee works. Job Code: Also known as Classification Code. Job Title (NOT working title): Classification Title derived from the four digit class code listing published by the State Controllers Office. Section B -- Employee Clearance The Department Designee is responsible for clearing each employee of all outstanding campus obligations. Send email to: separationchairs.csuci.edu to ensure the employee has no outstanding obligations. Write the date the employee is cleared in the Date Cleared box. Some clearances may require a more immediate (phone) notification of a pending resignation to ensure the integrity of the system/process. Direct extensions are as follows: ID card x8941; Parking Deduction for Parking x8430; University Keys/Key Cards/Keyless Entry x8960; University Library x8561; Accounts Payable x8593; Payroll x8487; Media Services x8946; PeopleSoft Access x8842; Procurement Card/AMEX x8481; Fee Waiver x8846). If the employee has remaining outstanding obligations, send employee to that department for signature clearance. The Department Designee should reconfirm the clearance in question before signing off on the document. (Continued on reverse side) Each Department should prepare its own checklist of required clearances (attaching a separate sheet for additional clearances as needed) as they pertain to the department. List all additional departmental clearances on the Separation/Clearance form as a record of all items returned and areas cleared. Destroy all CI ID cards after they are collected and notify OPC of an employees separation, pursuant to any key policies. Employees may go to Parking Services a few days before their last day to turn in their parking permit. Parking Services will collect the permit and issue a temporary permit through the separation date or last day on campus. If keys/key cards are lost or stolen, notify OPC (ext. 8960) immediately. After notifying Procurement, via email (using the separation chairs email) of the separation of an employee who was issued a Procurement Card and/or the AMEX Card, the card(s) must then be hand carried to Procurement, Administration Building East Tower, Room 2600. (Do not put the Procurement Card or the American Express card via intercampus mail or U.S. mail). Verify (via PeopleSoft Student Administration) that grades have been posted or appropriate action has been taken. 4) Section C Department Certification and Approvals a) The Department Designee should certify that the employee has cleared all outstanding obligations and has completed Section C on the form. This form will not be processed without the Department Administrator (or appropriate Department Designees) signature. Any exceptions to the clearance process need to be approved by the Department Administrator and the Associate Vice President of Human Resources Programs. After approvals are secured, the form and attachments should be forwarded (or sent with the separating employee) to Human Resources Programs, Administration Building, Room 1613 (ext. 8490). The separating employees final attendance report (Form 634) should be submitted to Payroll Services as soon as possible. The employees final pay warrant cannot be calculated until Form 634 is received. EMPLOYEE RESPONSIBILITY: (If the employee is not available to complete the Separation/Clearance form, the Department Designee should make sure that all of the information is complete on the form, including Section D. Information can be gathered via a phone call or other means. Department Designee should check the appropriate box at the top of Section D.) Section D Employee Responsibility Mailing Address: If left blank, all information and pay warrants will be sent to the address currently in the Human Resources database. Employee Signature: Employee acknowledges that s/he has returned all CI property and paid all debts, if applicable, owed to CI & understands the confidentiality statement. Employee acknowledges that s/he has resigned from CI. The employee will also receive the appropriate forms to withdraw or transfer his/her money from the retirement plan. Section E Resignations Select the appropriate reason for resignation. Employee Signature: Employee acknowledges that s/he hereby tenders the resignation from CI on his/her own accord. HUMAN RESOURCES/BENEFITS ADMINISTRATION: Section F HR Benefit Forms and Separation Checklist Benefits Coordinator will issue COBRA forms, allowing employees enrolled in health, dental and/or vision plans the opportunity to continue their coverage. The employee will also receive the appropriate forms to withdraw or transfer his/her money from the retirement plan. CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS Faculty and Staff Separation/Clearance Form ACOMPLETED BY DEPARTMENT OFFICE The Department Designee is responsible for ensuring that the Separation/Clearance process is properly completed for each separating employee. This completed form should be returned to Human Resources Programs, with authorized signatures no later than 3 business days prior to the employees separation date.CI ID #: Employees Name:Soc Security No: FORMTEXT       FORMTEXT       FORMTEXT      Last Day Physically Worked:  FORMTEXT      First Day of Separation Status:  FORMTEXT      First Day of Retirement Status (If Applicable):  FORMTEXT      Department/Program Name:  FORMTEXT      Job Code: HYPERLINK "http://www.calstate.edu/hrpims/salary.htm"CSU Job Code SearchJob Title (NOT Working Title): FORMTEXT       FORMTEXT      Employee Status:  FORMCHECKBOX  Staff  FORMCHECKBOX  Faculty  FORMCHECKBOX  MPP  FORMCHECKBOX  Permanent / Tenured  FORMCHECKBOX  Probationary / Tenure Track  FORMCHECKBOX  Temporary FORMCHECKBOX  Other:  FORMTEXT      BEMPLOYEE REQUIRED CLEARANCES Department Designee is responsible for clearing employee of all outstanding obligations within the department and other campus areas. Departments may have additional clearance needs that may be required for record keeping. Additional required clearances should be attached separately. All clearances indicated by * (asterisk) must be cleared prior to separation. To complete this section, SEND EMAIL TO: separationchairs@csuci.edu. Use cleared columns to indicate the date the re-email was received.Required Clearances:Date Cleared:Required Clearances:Date Cleared:*CSUCI ID Card:  FORMCHECKBOX  (Destroyed)  FORMCHECKBOX  N/A FORMTEXT       Final Attendance Form (STD. 634) MUST be attached FORMTEXT      *Payroll Deduction for Parking: Parking Decal Returned:  FORMCHECKBOX  Yes  FORMCHECKBOX No FORMTEXT       *Media Services FORMTEXT      *University Keys / Key Cards / Keyless Entry/ Locks Returned:  FORMCHECKBOX  Returned  FORMCHECKBOX  Lost  FORMTEXT      University Equipment Returned:  FORMCHECKBOX  Computers  FORMCHECKBOX  Cell Phones  FORMCHECKBOX  PDA  FORMCHECKBOX  Pagers  FORMCHECKBOX  Other: ________________ FORMTEXT      *Accounts Payable (Relocation Expenses/Advances) FORMTEXT      AIT-Computer Access: (Accounts, passwords, email, network access& )  FORMTEXT       *University Library FORMTEXT      *PeopleSoft Access - Update Appropriate Forms FORMTEXT      *Payroll  A/R s, etc. FORMTEXT      *Procurement Card/AMEX (See Instructions) FORMTEXT       Grades (Faculty Only) FORMTEXT      * Fee Waiver (If currently enrolled) FORMTEXT      CDEPARTMENT CERTIFICATION AND APPROVAL  Signature in this area must be on file in Human Resources Programs, via the Division Election Signature Form, to be valid.Department Director, Chair or Designee Signature:Print Name:  FORMTEXT      Ext:  FORMTEXT      Date:  FORMTEXT      DTO BE COMPLETED BY EMPLOYEE FORMCHECKBOX  Employee Unavailable to complete this form.Mailing Address --- This will change your Employment Record in Huma,[    T U o p z | ^_}~fg  !]`aij"#Cںڱڡڡںڡڡښڐںںڡں hiCJ]hiB* CJph3 hi6CJhi6>*CJ hi5CJhi5CJ\ hiCJ hi5CJ hi; hi;CJ hi;CJ hiCJhi5;CJhi5;>*CJhi6>*CJhi5,[\  T U p ] & F h^`gdi vv^v & F hv^`gdi !h & F !v ! 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Your Wage and Tax Statement (Form W-2) and any final warrants will be mailed to the address below: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       (Number, Street, Apt. No)(City)(State)(Zip Code) I have returned all University property and have paid all debts as listed above. The California Information Practices Act of 1977 requires the University to protect the confidentiality of employee and student personal information. During the course of my work with the University, I may have been given access to such information, e.g. employee names, home addresses, phone numbers, social security numbers, financial information. I understand that under California law, I am required to continue to maintain the confidentiality of any such information even though I am no longer working for the University. Employee Signature: Date:  FORMTEXT      ETO BE COMPLETED BY RESIGNING EMPLOYEE  if employee is resigning, reason and signature are required.Reason For Resignation (Select only ONE):  FORMCHECKBOX  New position provides professional advancement (01)  FORMCHECKBOX  New position provides better salary (02)  FORMCHECKBOX  New position has better working conditions (03)  FORMCHECKBOX  Dissatisfied with (policies, administration, support) (04)  FORMCHECKBOX  Dissatisfied with promotional opportunities and/or salary (05)  FORMCHECKBOX  Personal reasons (health, family, geography) (06)  FORMCHECKBOX  Other/Unknown (07)I hereby tender my resignation from . This resignation is executed by me freely and of my own accord. Employee Signature: Date:FHUMAN RESOURCES PROGRAMS This form and attachments are to be given to Human Resources Programs. 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