Please answer the following questions to terminate a Waged Employee (Work Study or Direct Wage). A separation of employment notice should be routed when an employee stops working earlier than the ending date of the assignment or when the source of payment is being changed.

	Enter Today's Date*
	mm/dd/yyyy

	First Name* This is the name of the employee being terminated

	Middle Name This is the name of the employee being terminated

	Last Name* This is the name of the employee being terminated

	Employee ID* This is the Employee ID of the employee being terminated. If the employee is new please enter 8 zeros as your response.

	Student ID Only fill this in if the employee is a currently enrolled student.

	Please provide the Assignment Number that is being terminated.* This can be obtained through Oracle. Example: 70054321-9. The number after the dash (-) is the Assignment Number. If this the employee's first time working with the university please enter "Initial Assignment" as your response. This will also be verified by Student Employment staff.

	Select the appropriate Job Code:*
	Workstudy Direct Wage

	Job ID This would be the Job ID for the position that the employee's Report-A-Hire is connected to.

	Organization Name*
	-- Please Select --Accelerated Alternative Program for Teacher Prep and CertAccounting and Business LawArtBaylor Premedical Honors College ProgramBiologyCenter for Advisement Recruitment Internship and RetentionCenter for AgingCenter for Applied Research in EducationCenter for Border Economic StudiesCenter for Latin American StudiesCenter for Learning Teaching & TechnologyCenter for ManufacturingChemistryClinical Laboratory Sciences ProgramCoastal Studies LaboratoryCollege of Arts and Humanities Deans OfficeCollege of Business Administration Deans OfficeCollege of Education Deans OfficeCollege of Engineering and Computer Science Deans OfficeCollege of Health Sciences and Human Services Deans OfficeCollege of Science and Mathematics Deans OfficeCollege of Social and Behavioral Sciences Deans OfficeCommunicationCommunication Sciences and DisordersComputer Information Systems and Quantitative MethodsComputer ScienceContinuing EducationCoordinated Program in DieteticsCriminal JusticeCurriculum and Instruction Elementary and SecondaryCurriculum Resource CenterEconomics and FinanceEducational LeadershipEducational Leadership Doctoral ProgramEducational PsychologyEducational Technology Resource CenterElectrical EngineeringEnglishEnglish Language InstituteFaculty SenateGraduate AdmissionsHealth and KinesiologyHistory and PhilosophyHonors Studies ProgramInstitute for Population Health PolicyInternational ProgramsLibraryManagementManufacturing EngineeringMarketingMathematicsMBA Program in BusinessMechanical EngineeringMexican American Studies ProgramMilitary Science Army ROTCMinority Biomedical Research ProgramModern Languages and LiteraturesMusic and DanceNeuhaus Center for Entrepreneurship and Economic EducationNursingOccupational Therapy ProgramAcademic CentersOffice of Academic Affairs Faculty AffairsOffice of Academic Affairs Graduate StudiesOffice of Academic Affairs ResearchOffice of Academic Affairs Undergraduate StudiesOffice of Academic AssessmentOffice of Field ExperienceOffice of Research and Sponsored ProjectsOffice of Student Engagement and Experiential LearningOffice of the ProvostPharmacy ProgramPhD Program in BusinessPhysician Assistant ProgramPhysics and GeologyPolitical SciencePre Med ProgramPsychologyPublic Administration ProgramRaul Yzaguirre CenterRehabilitative ServicesSmall Business InstituteSocial WorkSociology and AnthropologySouth Texas Border Health Disparities CenterSpeech and Hearing CenterStatistical Consulting CenterStudent PublicationsTexas Manufacturing Assistance CenterTheater Box OfficeTitle VUniversity Office of Teacher CertificationUniversity Retention Advisement ProgramUniversity Writing CenterUT System Tex Mex Border Health Coordination OfficeUTPA PressAssets ManagementAuxiliary and Print ServicesBudget OfficeBusiness Technology OperationsCommunity EngagementComptrollerEnvironmental Health and SafetyFacilities ManagementFinancial Aid AccountingHuman ResourcesMaterials ManagementOffice of the VP for Business AffairsPolice DepartmentPrivacy and SecurityApplication and Computing ServicesComputer CenterEnterprise Information SystemsInternet ServicesIT Help DeskIT SecurityNetworksOffice of Information TechnologyOffice of Information Technology SupportProject Management OfficeRecords ManagementTechnology SupportTelephone ServicesAthleticsInstitutional Research and EffectivenessOffice of Audits Compliance and Consulting ServicesOffice of the PresidentAcademic Advising CenterAdmissions and New Student ServicesCareer ServicesChild Development CenterCollege Access and Support ProgramsCollege Assistance Migrant ProgramCounseling CenterDisabilities ServicesEducational Talent SearchGear UpHigh School Equivalency ProgramInternational Admissions and ServicesIntramurals Recreational SportsLearning Assistance CenterOffice of Enrollment ServicesOffice of High School to University Programs and Testing ServicesOffice of Student Support ServicesOffice of the Dean of Students and Associate VPOffice of the VP for Student AffairsOutreach and RecruitmentRegistrarResidence LifeStudent Financial ServicesStudent Health ServicesStudent InvolvementStudent Judicial AffairsStudent Life and Transition ServicesStudent UnionTexPrep Engineering ProgramTutorial ServicesUpward Bound Math and Science ProgramUpward Bound ProgramVeterans OfficeWellness and Recreational SportsAlumni RelationsDevelopment and Advancement ServicesOffice of the VP for University AdvancementPublic AffairsUniversity Marketing and Communications

	Project Number*

	Position Number* This can be found on the Memorandum of Employment. You can also find it in the Report-A-Hire.

	Termination Date* This date needs to be the last day the employee physically worked in your office.
	mm/dd/yyyy

	Official UTPA Job Title*
	Professional Non Student Technical Non Student Skilled Maintenance Non Student Skilled Staff Non Student Office Aide Non Student Professional Student Technical Student Skilled Maintenance Student Skilled Staff Student Office Aide Student

	Reason for Termination* Please select the reason for termination that best applies
	Resigned Discharged Death Retirement Transfer to other Project Number Transfer to other Department Other, please specify

	Supervisor Name*

	Name of Person completing this form*

	How many hours did the employee work in their last month with your department?*

	If the employee is a Work Study, how many hours in total did they work with your department this semester? Answer this question for Work Study positions only. This information is needed so the Work Study Office can adjust the student's remaining award for the semester.

	Did the employee submit a time card prior to their termination?* If the individual did not complete a time card please contact: Payroll Office, Administration Building Room 221, (956) 665-2558, payroll@utpa.edu
	YesNo