PT.

VIRTUS FACILITY SERVICES

FORMULIR KARYAWAN BERHENTI
Berhenti atas permintaan sendiri Diberhentikan

Diisi oleh karyawan bila berhenti atas permintaan sendiri / diisi oleh yang mengajukan pemberhentian :

Nama : ...................................................................................................................... NIK : .......................................................................

Tanggal mulai bekerja : .............................................................. Tanggal berhenti bekerja : ......................................................................

Area Terakhir : ................................................................................ Jabatan : .................................................................................................

Alasan : ................................................................................................................................................................................................................

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Disetujui oleh, Diajukan oleh,

(.................................................) (.................................................)
Tandatangan & Nama Jelas Tandatangan & Nama Jelas

Checklist time sheet , seragam / sepatu :

Karyawan ini masih berhak atas gaji sejumlah ................ (............................................................................................) hari kerja
Periode : ........................................................................... s/d .........................................................................
Seragam sejumlah : ...................... Baju dan ................ Celana
Sudah diterima oleh, Nama : .............................................................................................................. Ttd : ........................................
Sisa cicilan sepatu sejumlah Rp . ............... ............................... (......................................................................................................)
Administrasi oleh, Nama : ................................................................................................................. Ttd : ........................................
Exit interview (diisi bila berhenti atas permintaan sendiri)

Diinterview oleh, Nama :................................................................ Jabatan : ................................................ Ttd : ........................................

Alasan berhenti : .................................................................................................................................................................................................
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Saran untuk perbaikan : .......................................................................................................................................................................................
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Registrasi Karyawan Berhenti pada bagian personalia (diisi hanya oleh bagian HR)

Registrasi karyawan berhenti sudah diotorisasi oleh,

Nama : ........................................................................................................... Ttd : ..........................................................................
ID Card sudah dimusnahkan oleh,
Nama : ........................................................................................................... Ttd : ..........................................................................
Sesudah gaji terakhir dibayarkan, nomor rekening ybs sudah dihapuskan dari bagian personalia oleh,
Nama : ........................................................................................................... Ttd : ..........................................................................