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STAFF HUMAN RESOURCES • UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN
52 EAST GREGORY DRIVE • CHAMPAIGN • ILLINOIS • 61820 • (217) 333-2143
EMPLOYEE RESIGNATION FORM
If you would like to talk to someone in Labor and Employee Relations before completing this form, please let us know. We
will make every effort to arrange a meeting at this time or we will schedule an appointment for you as soon as possible.
Name: ___________________________________________________ UIN: ___________________________________
Department: ________________________________________________________________________________________
Classification: ______________________________________________ Civil Service Number: _____________________
Resignation Effective Close of Business: _________________________________________________________________
FOR STAFF HUMAN RESOURCES USE ONLY
Last day of work per department (if different)_____________________________________________________
HOME ADDRESS
Address:
__________________________________________
__________________________________________
Phone :
__________________________________________
Reason for Resignation:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
I certify that this resignation is executed by me voluntarily and of my own free will.
_________________________________
Employee Signature
Date
_________________________________
Accepted
Date
cc: Staff Human Resources
Employee
Department
Civil Service System
STAFF HUMAN