Employee Termination Form

The Delaget Payroll team is ready to work on your case! This form is used for employees that have been terminated. Please fill in all fields on the form below. Also, please ensure that you put the title, name and email of the person filling out the form at the bottom. This is how we connect the case to your account and can provide you with updates as we work through the case. As always, please reach out to us if you have any concerns or questions. Thank you


Employee ID:

Employee Name:

Company/Entity:

Restaurant #/District Manager:

Last Day Worked:

Start/Effective Date:

Termination Type:

Termination Reason:

Eligible for Rehire:

Shirts Returned:

Pants Returned:

Jackets Returned:

Amount Returned:


Contact Role: