Staff & Administrators Separation & Resignation

Responsibilities

• It is the responsibility of the appropriate administrator or their designee to initiate the separation process via the Form 109
• It is the responsibility of the employee to route the Separating Clearance Form.

Considerations

• Check if any sick days or vacation days will be taken (important for final absence reporting and vacation payout projections)
• Confirm last day physically working
• Confirm last day on pay status

This process involves two parts:

1. Completion of the Form 109
2. Routing of the Separating Clearance Form

This process should be initiated when the final separation date has been established but no later than 2 weeks prior to separation.

Part 1: The Form 109 and Separating Resources

1. Administrator or designee completes Form 109 located at Report of Separation for Staff - (Electronic) | Cal Poly Humboldt Forms
2. Form 109 Notification of Separation is dynamically routed for approval.
3. Manager reviews the following resources:  
   1. Managers Digital Resource Checklist
   2. Departing Employee Documentation
4. HR/Payroll receives the approved Form 109.
   1. Payroll separates the employee in Peoplesoft.
   2. Peoplesoft access is then removed for the separated employee

Part 2: The Separating Employee Clearance Form

There are two forms for separation employees that are automatically sent when completing the Form 109:

1. Campus: Separating Employee Clearance Form
2. Housing: Separating Employee Clearance Form

For CAMPUS employees:

STEP 1: Employee completes the employee portion of the form.

STEP 2: Employee to coordinate with manager or designee in the appropriate department to return university-owned materials and equipment.

Including:

• Laptop (home department)
• Library books or equipment (Library)
• Other equipment (home department/other)

STEP 3: Employee works with the Cashiers Office to return the following:

• The Separating Employee Clearance form
• Employee identification card
• Key(s): (the Cashiers Office will have a list of keys to return)
• Parking permit
• ProCard
• Travel Card
• Other (as noted by manager)

The Cashier’s Office will determine any outstanding financial obligations for the employee.
NOTE: All keys must be returned to Facilities Management. Do not return keys to your department.

Cashier's Office: SBS Building, 2nd Floor.  Monday - Friday 8am - 4pm.

Important notes:

• If the employee is not available to complete the process, the appropriate administrator or their designee must complete the process for them as outlined above.
• If the employee is a faculty member, the appropriate administrator should contact aps@humboldt.edu for instructions.
• If the employee is in housing, they will follow the housing process.
• The Separating Employee Clearance form will be routed to HR, ITS, and Facilities Management.