Voluntary Separation Form - Executive Office Shared Environment

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)

AP Sub-Units(Required)

ASA Sub-Units(Required)

DCCS Sub-Units(Required)

HSS Sub-Units(Required)

PRES Sub-Units(Required)

Action Request

Last Date of Employment(Required)

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

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

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.