Departing Employee Form Departing Employee Information Supervisor's email address Required Departing Worker is a(n) Required Please select DOJ Employee Contingent Worker Temporary Worker AmeriCorps participant Division of Departing Worker Required Please select CSD DCI FSD GCD AGO MBCC MHP MLEA MVD NRDP POST Employee Full Name Required Employee ID Number Required Employee CJ Number Required Timeline Last Day worked Will the worker use any leave time between their last day in the office/working and their last date of employment? Required Yes No Effective date computer access should be terminated Required Effective Time computer access should be terminated Required Display time of day as HH:MM am or HH:MM pm. Employee's last day of work, detailing any approved leave to be taken Status of Departure Transferring or Leaving State Government Required Leaving State Government Transferring within State Government Transferring within DOJ Which department within State Government? Administration Agriculture Arts Council Auditor Commerce Corrections Environmental Quality Fish, Wildlife & Parks Governor's Office Higher Education, Commissioner of Historical Society Judicial Branch Labor & Industry Legislative Branch Livestock Lottery Military Affairs Public Employees Retirement Administration Natural Resources & Conservation Political Practices, Commissioner of Public Defender, Office of the State Public Education, Board of Public Health & Human Services Public Instruction, Office of Public Service Commission Revenue School for the Deaf & Blind Secretary of State Securities & Insurance, Commissioner of State Fund State Library Teachers Retirement System Transportation Universities & Colleges List of State Agencies found at https://mt.gov/govt/agencylisting.aspx DOJ Division Transferring to CSD DCI MBCC GCD FSD JITSD MHP MVD AGO NRDP POST Please note any access this employee should retain for transitional purposes. Submit a ticket at a later date to remove access. Is the Employee a Supervisor? Required Yes No Does the employee have a state credit card (procard)? Required Yes No
