University of Nebraska Kearney

UNK

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Human Resources
Employee Checkout Form
 

This form should be completed for all faculty and staff including GA's and adjuncts.

First Name: *

   
"Known As" Name:   
Middle Initial:   
Last Name: *   
NU ID: *   
Department: *   
Job Title: *   
Last Working Day: *   
Last Day Paid-university services such as Blackboard, WebSMART and Email will be discontinued on this date (if left blank, services will be discontinued on last working day) *   
Department Office Associate's Name: *   
Department Office Associate's Email   
Supervisor's Email *   
Supervisor's name: *   

Forwarding Address
Street:   
City:   
State:   
Zip:   
Email:   
If retiring, do you want to keep your email?
 
      
 
Additional Comments (Not required):    

 

 

 

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