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Forms :: Exiting Employee

 

As a courtesy to our customers, Information Technology Services has implemented this web-based form that exiting employees can use to gain clearance from our department (section #2 of the HSU SEPARATING EMPLOYEE CLEARANCE FORM).

This web-form is only to be used to gain clearance from ITS -- all exiting employees must complete the HSU CLEARANCE FORM to properly exit the university.

Requestor's Email address or name:
(or name if no email address)
Name of person filling out form:
Faculty or Staff: Click to see types
  (If the faculty member is not sure that they are Emeritus Faculty
they can contact the Faculty Personnel Office at 826-5086)
Name: First MI
Last
Separation Date:
Department:
HSU ID:
HSU Phone: ( Leave blank if not applicable.)
Listed with campus operator: No Yes
HSU Calling Card: No Yes
HSU email account No Yes
  If yes, please provide entire email address. (eg. jdk###@humboldt.edu)
@humboldt.edu
Keep personal e-mail account active for 6 months: No YesNote: Only axe email accounts can be extended for 6 months.
Other HSU accounts:

(Please list additional accounts separately)
Meeting Maker Account: No Yes Unsure
Banner Forms User (Not Banner Web) No Yes Unsure
  If yes, what is Banner username:
Uses PeopleSoft Online No Yes
  If yes, what is PS username:
Teaches Using Blackboard No Yes
Teaches Using Moodle No Yes
Comments:
(Leave blank if not applicable)

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