UNM Policy 3225A

SEPARATION CHECK-OFF LIST FOR STAFF EMPLOYEES
Last Revised: 03/01/06

NAME__________________________________________________________________SS#________________________________

DEPARTMENT________________________________DEPARTMENT PHONE________________________________

FORWARDING MAILING ADDRESS:____________________________________________________________________________

HOME PHONE (______)_____________________

	AUTHORIZED SIGNATURE
1.*Manager: Submit UNM Staff Employee Separation Form to Human Resources Has employee turned in the following items to you? If applicable: Cell phone____Pager____Calling Card____ Please request deactivation of calling card, long distance authorization code, cell phone and/or pager and remove the individual's access to voicemail. This can be accomplished by contacting Telecommunications at telecom@unm.edu.	Employee's Supervisor
2. Purchasing or Health Sciences Controller's Office (if applicable) Turn in: A. Purchasing Card _______	Sign here:
3. Property Accounting-Turn in University equipment (if applicable)	Sign here:
4..Risk Management Department (if applicable) A. Turn in radiation badge ____ B. +Close out procedure for chemical/biological agents ____	Sign here:
5. Parking Services-Parking Permits (required)	Sign here:
6. General Library or Health Sciences Library for HSC employees-Circulation Desk (required)	Sign here:
7.Physical Plant Lock Shop-Turn in keys (required)**	Sign here:
8. Bursar's Office (required)	Sign here:
9. University Department of Human Resources (required): A. Obtain Insurance Benefits Information____ B. ++Complete Exit Interview____ C. Return UNM ID - Benefits Office____ D. Complete Retirement Reimbursement Form____	Sign here:
10. Return Completed Check-Off List	Sign here:

Health Sciences Center employees must return this form to the University Health Sciences Department of Human Resources after completion. All other employees must return the form to the University Payroll Department.

*The UNM Employee Separation form and this Check-Off List should be started at least ten (10) working days in advance of the separation date or as soon as the department becomes aware that an employee is separating. The manager may sign-off indicating N/A for those areas that are not applicable. If the area indicates the signature is required, the employee must obtain the required signatures.
**The following departments should continue their present procedure for turning in keys: NMERI/Children's Psych Center/Physics & Astronomy/Mental Health Center/Housing/New Mexico Union/Branch Campuses.
+If you work with materials of a chemical or biological nature, please call the Risk Management Department 10 (ten) days prior to your departure for close-out procedure.
++The exit interview is not required but the information you provide is helpful to UNM in determining trends and will only be used to analyze and report those trends as a part of summarized data. The information will not be released to your manager/supervisor. If you prefer, you may submit the interview anonymously; you are not required to provide your name. You may access the exit interview at: http://www.unm.edu/~hr/current staff/.
If you are interested in retirement reimbursement, please contact the University Payroll Office.

Comments may be sent to UBPPM@UNM.edu
http://www.unm.edu/~ubppm

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