Return Of Company Property

NAME OF EMPLOYEE: ______________________________________________________________

Please print

EFFECTIVE DATE OF SEPARATION: _____/_____/_____

Please check property returned (if not applicable to employee, indicate N/A)

_____ Keys

_____ Company Credit Card

_____ Gasoline Credit Card

_____ Company I.D.

_____ Laptop

_____ Printer

_____ Other Electronic Equipment: ___________________________________________________

_____ Cell Phone

_____ Pager

_____ Company Documents: ________________________________________________________

_____ Uniform

_____  Other: ____________________________________________________________________

Employee Signature: ______________________________________Date: ____/____/____

Supervisor Signature: ______________________________________Date: ____/____/____

Human Resources Signature: ________________________________Date: ____/____/____