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1
Step 1
Employee Resignation Form
Personal Information
First Name
Last Name:
Cell Phone
(xxx-xxx-xxxx)
Email
(must be filled out to send form)
email
Assigned Facility:
Resignation Information
Has the Manager been notified:
(Choose One)
YES
NO
Has the Supervisor been notified?
~ Choose One ~
YES
NO
Last day of work
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Reason for Leaving:
0
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713-771-7665 
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