Forms – HR – PBF Separation Notice

Name*

First Last Pin

Hire Date

Last check date

Market Number*

Supervisor*

Phone*

Last Date Worked*

Reason for Separation (Voluntary)

Reason for Separation (Involuntary)

Would you Rehire?*

If other, list reason for separation.

Confidential Evaluation of Employee

Attendance*

Cooperation*

Initiative*

Quality of Work*

Productivity*

Work Habits*

Relationships*

Comments*

Evaluation Summarized by*