Voluntary Separation – Request Form Voluntary Separation Step 1 of 3 33% Preparer Information Preparer Name(Required) Your name First Last Preparer UW Email(Required) Your UW email address Alternate Contact In the event of your absence, who should be contacted? First Last Alternate Contact UW Email Alternate contact's UW email address EO Assistance(Required) Did you consult with or receive assistance from an Executive Office Shared Environment team member prior to filling out this form? No Yes Team Member Name First Last Employee Information Name(Required) Name of employee who is separating First Last UW Email(Required) UW email of employee who is separating Employee ID Number(Required) Employee Unit(Required) -CHOOSE ONE-Academic Personnel (AP)Academic and Student Affairs (ASA)President (PRES)Provost (PROV)Faculty SenateHealth Sciences Services (HSS)Division of Campus Community Safety (DCCS)Attorney General's Office (AGO) AP Sub-Units(Required) -CHOOSE ONE-AP: CoreAP: Ops, AHR, PIMAP: Ops ISOAP: Faculty Advancement ASA Sub-Units(Required) -CHOOSE ONE-ASA: Academic Technologies (AT)ASA: AdmissionsASA: AdvancementASA: Center for Teaching and Learning (CTL)ASA: CoreASA: Financial AidASA: Information Services (ASA-IS)ASA: International Student ServicesASA: RegistrarASA: Strategic Initiatives DCCS Sub-Units(Required) -CHOOSE ONE-DCCS: CoreDCCS: SafeCampusDCCS: Emergency ManagementDCCS: UWPD HSS Sub-Units(Required) -CHOOSE ONE-HSS: Academic Services & Facilities (AS&F)HSS: CoreHSS: Interprofessional Education (IPE) PRES Sub-Units(Required) -CHOOSE ONE-PRES: Board of Regents (BOR)PRES: CorePRES: Environmental Health & Safety (EH&S)PRES: Internal Audit (IA)PRES: OmbudPRES: Population HealthPRES: University Rules & PolicyPRES: UWINCO Action Request Last Date of Employment(Required) MM slash DD slash YYYY Voluntary Separation Reason(Required) Moving to other WA state agency Leaving WA State employment Retiring from UW Transferring to different UW department Please note, this option is for employees that will be officially retiring from the university. Please direct the retiring employee to the Preparing to Retire Benefits webpage to ensure proper steps have been taken to complete their retirement properly. New UW Department(Required) Resignation Documentation(Required) EOHR requires both the employee's resignation and documentation of the supervisor's acceptance in order to process this request. Please upload both. Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, jpeg, Max. file size: 15 MB, Max. files: 5. Documentation Upload Upload any additional documentation that would be helpful to the EOHR Team when reviewing this request. Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 15 MB. Additional Information Upload any additional documentation that would be helpful to EOHR Team when reviewing this request.