Office of Civil Rights On-the-Job Training Program

Trainee Departure Form

This form must be submitted to the OJT Coordinator within 15 calendar days of a trainee voluntarily or involuntarily leaving employment. A Trainee Departure Form is not required for seasonal layoffs.

Contractor Information

SP Number*

Contractor Name:*

EEO Officer Name:*

EEO Officer Email Address:*

EEO Officer Phone:*

Trainee Information

Trainee name:*

First Name

Initial (optional)

Last Name

Date of trainee departure:*

Reason for trainee departure:*

Voluntary (Quit/Resigned) Involuntary (Terminated) Other

Provide a brief explanation for employee departure:*

Equal Employment Opportunity Employer

Note: Any information that you provide is considered public data under the Minnesota Government Data Practices Act, Minnesota Statutes, Chapter 13. This means that if someone, including the news media, requests this information we are obligated to provide it to them under the Minnesota Government Data Practices Act. See disclaimer.