(Employee Service Form)
Name:
Date of Joining: Date of Release:
Employee Designation:
Employee ID: Adress:
Email id: Mobile No:
S.No Clearance Details Clearance By: Signature
Administration Department
1 Employee ID Card/Access Admin
Card
2 Drawers cleared and keys Admin
returned
3 Mobile Handset Admin
4 Balance Visiting Cards Admin
5 Sims Cards Admin
Remarks Admin:
IT Department
1 Laptop / Desktop and IT Dept.
Accessories
2 Pen drive IT Dept.
3 Deactivation from Mailing IT Dept.
List
4 Gadget Item IT Dept.
Remarks IT Department:
Accounts Department
1 Loans Account
s
2 Company Bank card Account
s
3 Settlement of all dues Account
s
4
Submission of all expense Account
vouchers due. s
Remarks by Accounts Department:
HR
1
Acceptance Letter subject to HR
clearance of dues. Person
2 Termination of record in HR
software if any Person
3 Notice period to be HR ________days;
recovered Person
Remarks by HR:
Employee Given Document Given Date Received Date
Remarks:
Note: * This form should be returned to HR- Department, on or before the last
working
day
**Please do not keep any of the field empty, as incomplete form will not
be
entertained
***Some of the fields may not be applicable to all, in such case please
mention N/A
**** Please submit the balance reimbursement and Income Tax proof
documents
along with the clearance form
Employee Signature: __________________________
Date: _________________________________
