NAME: ______________________________

Position: ____________________________
OUTLET/OFFICE:
Outlet Name

Date hired: _______________

Date ended: ______________
Operations:

Signatory

Cleared

Hold

Remarks: ______________________________
______________________________________
_________________________________
Signature over printed name
____________
Date

Cleared

Hold

Admin/Finance

Remarks: ______________________________
_______________________________________
_________________________________
Signature over printed name
____________
Date

IT/MIS
Cleared

Hold

Cleared

Hold

Remarks: ______________________________
______________________________________
_________________________________
Signature over printed name
____________
Date
Human Resources
ID: _________

Remarks: _______________________________
_______________________________________
_________________________________
Signature over printed name
____________
Date

ATM: _______________
CP: __________________
Exit Interview: ______________
Cleared

Hold

Remarks: _________________________________

_________________________________________
rev. 5/12

Signature over printed name