Resignation/Final Employment Date
Full Legal Name: *
Your answer
Date and time of your last session - Include Client(s) first/last name *
Ex- John Smith - 9/15/19, 5-9pm.
Your answer
Final Date of Employment *
MM
/
DD
/
YYYY
Mailing Address for your Final Check *
Your answer
Clients you are working with and/or Set Schedules (include specific days/times, special instructions) *
Ex- I work with Client A on Tuesdays/Thursdays from 12pm-6pm, Client A has 2 younger siblings. I work with Client B every other Saturday from 5-10pm and I schedule directly with Client C, Client D and Client E.
Your answer
If you have other information that we need to know about, please add below.
Your answer
If you plan on returning during a school break please mark the following
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