IT – Employee Resignation\ Termination

YOUR Email Address*

Name

First

Last

Job Title*

Email Address*

Last Day of Employment*

Location*

Department*

Office/Cubicle Location*

Additional Requests

Accounts that need to be deactivated

Harvest

Copia

Advanced MD

Computer\Server account

email

Salesforce

Google Drive account for Billing

please check any accounts that this user had so that they can be deactivated

Equipment Returned

computer

monitor(s)

mouse

keyboard

printer

please select all that apply

Additional Equipment returned

This field should be left blank