{{company_name}}
{{company_address}}
Phone: {{phone}} | Email: {{email}} | Web: {{website}}
Form Title
Reemployment Eligibility Record
Purpose
Complete the reemployment eligibility record as part of a lawful, fair and well-documented separation process.
Employee Information
| Field | Value |
|---|---|
| Full Name | {{employee_name}} |
| Employee ID | {{employee_id}} |
| Job Title | {{job_title}} |
| Department | {{department}} |
| Manager | {{manager_name}} |
| Effective Date | {{effective_date}} |
Details
| Field | Value / Notes |
|---|---|
| Eligible Yes/No | _______________________ |
| Conditions | _______________________ |
| Reviewer | _______________________ |
| Effective Date | _______________________ |
| Notes | _______________________ |
Instructions
- Confirm legal and policy requirements have been satisfied.
- Attach all supporting documents and evidence.
- Issue copies to the employee, payroll, HR and the line manager.
Certification
I confirm the information captured is accurate and that due process has been followed.
Signatures
| Signature | Date | |
|---|---|---|
| Employee: {{employee_name}} | ____________________ | {{date}} |
| Manager: {{manager_name}} | ____________________ | {{date}} |
Grounds & Effective Date
| Field | Value |
|---|---|
| Employee | {{employee_name}} ({{employee_id}}) |
| Role | {{job_title}}, {{department}} |
| Last Working Day | {{effective_date}} |
| Notice Period | As per employment contract |
| Reason Category | Resignation / Mutual / Redundancy / Cause |
| Issuing Manager | {{manager_name}} |
Final Settlement
| Item | Amount / Status |
|---|---|
| Salary up to Last Working Day | |
| Accrued and Unused Leave | |
| Pro-rated Bonus (if applicable) | |
| End-of-Service / Gratuity | |
| Outstanding Loans / Advances | |
| Net Final Payment |
Exit Checklist
Continuing Obligations
- Confidentiality obligations as set out in the employment contract continue indefinitely.
- Any non-solicitation and non-compete clauses remain enforceable as agreed.
- Intellectual property assignments remain in full force.
- The Employee will not represent themselves as acting on behalf of the Company after the last working day.
Right of Appeal
Where this letter relates to a termination for cause, the Employee may submit a written appeal within seven (7) calendar days to the Head of HR. The appeal will be reviewed in line with the Company's grievance and disciplinary policy.
Acknowledgement
Document Control
| Field | Value |
|---|---|
| Document Owner | Human Resources — {{company_name}} |
| Category | Termination |
| Version | 1.0 |
| Effective Date | {{date}} |
| Next Review | Annually from effective date |
| Approved By | {{manager_name}} |
| Classification | Internal — Confidential |
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