Facilities Information Systems

Complete this form to initiate employee separation processes.

If you have any questions, concerns, or issues related to the use of this form, contact the Systems Analyst at ext. 7351.

Employee Separation Request

Employee's Full Name*

Employee's W Number*

FM Shop*

Employee Type*

Manager's Email*

Last Working Day*

Employee's FM-issued keys*

Does employee have a Prox Card?*

Start Process to Hire Replacement?*

Have all uniforms been returned?*

Additional Comments (Include information regarding returned keyrings/keys)

*Required