EMPLOYEE RESIGNATION

GENERAL INFORMATION

Employee Name *

Employee PIN: *

Position: *

Last Day of Employment: * +

Branch *

Facility / Facilities: *

Supervisor: *

Is your supervisor aware of your resignation? *

Yes

No

REASON FOR RESIGNATION

Reason for Resignation:

TERMS

By completing this online resignation form, I understand that I may be contacted by the Midwest Janitorial Service, Inc. corporate office for a number of reasons, including but not limited to: 1) confirmation of resignation; 2) additional information pertaining to the reason for your resignation; 3) any information for payroll purposes; 4) client facility access, including keys and key cards; 5) to update employee contact information for legal purposes, etc.

By checking this box, I agree to the terms of MJS contacting me for additional information. Failure to agree to these terms may result in the delay of processing your request.

I agree

...................................................................

By completing this online resignation form, I understand that if I have not returned the company's property, I will be contacted to make arrangements for the company to collect these items. Failure to return the company's property may cause a delay in payment until all property is returned; theft charges; rekeying charges, etc. I understand property includes, but is not limited to: Keys, Key Fobs, Uniforms, Badges, Cleaning Equipment and in some cases, Vehicles, Phones, Computers, and Credit Cards.

By checking this box, I agree to the terms for returning company property. Failure to agree to these terms may result in the delay of processing your request.

I agree

...................................................................

I agree that the resignation I complete will read as follows:

I, YOUR NAME HERE, would like to inform you that I am resigning from my position as YOUR POSITION HERE, for Midwest Janitorial Service, effective LAST DAY.

By checking this box, I agree to the terms of the resignation letter. Failure to agree to these terms may result in the delay of processing your request.

I agree

COMPLETED BY

Signature: *

clear

Date Completed: * +