This checklist assists departments, employees, and Human Resources complete the termination process. It should be completed prior to employee's last day of work. Departments: Fax this form to Benefits Office at 312/996-5733.
Mail Code: (M/C)________ Supervisor Name/ Phone #: ____________________________
Employee Responsibility
Submit resignation, if appropriate
Contact State University Retirement System (SURS) 1-800-275-7877, particularly if retiring
Access NESSIE: update W-4 form, address and phone number (final W-2 mailing)
Give contact information to Benefits
Return University I-Card (Photo ID Office at 1790 SSB or 241 CIU)
Cancel parking/transit allotment
Tuition Waiver
UIC Library fees / books returned
Turn in keys/access card
Determine if you wish to donate unused sick leave to Shared Benefit Program; process via NESSIE
Clean out desk/locker
Submit any outstanding Medical Care Assistance Plan (MCAP) and/or Dependent Care Assistance Plan (DCAP)
claims to Fringe Benefit Mgmt Co., 800-342-8017
Check the box for benefit items that apply to you:
I am transferring to another State of Illinois organization
I am retiring
I have Health and/or Dental Insurance
I have Reliastar Term Life Insurance
I have Long-Term Disability insurance
I have Life Insurance
I contribute to a 403B Savings Plan
I contribute to a 457 Savings Plan
Department Responsibility
Provide IDES brochure or online link
Collect building keys/access card, credit card, office supplies and equipment
Contact Facilities Management to remove access to building
Terminate employee access to computer systems
Terminate EPAF authorization, if applicable
Terminate voicemail/e-mail message
Audit final time card and pay. Note: Final payout should not be forwarded to Payroll until keys, equipment and other items have been collected by the unit
Submit PITR to end job within five days of termination date; can be sent before last day
Update Taken field on PEALEAV after final calc date; may need to adjust Accrued for partial month
Process DART separation
Process Pay Adjustment, if pay-out due. Note: Final payout to be made only when there is no outstanding balance owed by employee
Fax completed Employee Exit Checklist to Benefits Office at: 312/996-5733.
Benefits Office Responsibility
Notify CMS if employee is transferring to another State of Illinois organization
Advise of COBRA for Health and Dental Insurance
Advise of portability for Reliastar Term Life Insurance.
Advise of portability for Long-Term Disability
Advise of 30-day portability for Life Insurance.
Advise of options for 403B Savings Plan
Advise of options for 457 Savings Plan
Notify CMS of discontinued contributions to MCAP/DCAP
Supervisor/Dept Head Signature _________________________________ Date: ____________