IBM 2013 TERMINATION INFORMATION FORM

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25 Νοε 2013 (πριν από 3 χρόνια και 10 μήνες)

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IBM 2013 TERMINATION INFORMATION FORM


Please
take as much room needed to full
y

respond/provide required information
.





PERSONAL INFORMATION


Name:
_______________________________________
_______
______
____
______________


Home Address:
_________________
_____________
_
___
_____
______
__________________


Home phone:
___________________
__
___
_
_

Cell phone: _
___
__
____
_________________


Personal email address: __
_______________________________
______
_________________


Date of Birth: ___________________________
___
_________________
______
___________


Age:
__________
_____





EMPLOYMENT INFORMATION


Job Title at IBM
:
_________________________________________________
_
___
__


Salary:
________________
__________________________
______________
_
_
___
__


Bonus:
________
______________________________________________
_________


Benefits:
____________________________________________________
__________


DC Pension:

______________________________________________________
_____


Other Compensation:
______________________________
_____________________
_


Please p
rovide copies of p
aystubs
and

T4s. If possible, identify the bonus payments r
eceived for
2012, 2011 and 2010
.







2

of
3


Job Description

(incl. Managerial)
:
__
______________________________
____
____________


_
___________
___________
_________________________________________
______
______


______________________________________________________________________
______


If possible, please attach a copy of your job description.


Date of Hire:
_____________________________
___
____


Years of S
ervice:
_________________________________


Do you have an e
mp
loyment contract/offer l
etter?
____________________________
______


If yes, please attach a co
py of your employment c
on
tract/o
ffer
l
etter.


Were you transferr
ed from Cognos
(or elsewhere)

to IBM
?

____________
____________
______
_____


If yes, what was your start date with Cognos
,

and when did you transfer to IBM?
______________________________________________________________________
______


____________________________________________________________
__________
______


If yes
, please attach a copy of any employment contract/offer letter that you received on transfer.


W
ere you induced

or aggressively recruited

to leave other employment to come to IBM or
Cognos?_______
_
_________


If yes, please provide f
ull details

of recruitment

(including
any
documents)___________________________________________________________________


Do
you have any health issues?
________
_
____
_______________________________
______


If so
,

please describe your condition and any limita
tions you have
(including details regarding
medication and cost, treating docto
rs and provide medical reports

if available
)
:


______________________________________________________________________
______


____________________________________________________
__________________
______


Have you in the past or are you currently in rece
ipt of disability benefits?
____________
______


If yes, please provide full details:

___________________________________________
_______


____________________________________________
__________________________
______




3

of
3





TERMINATION OF EMPLOYMENT


Date Provided Letter re Formal Notice of Termination:

_________________________


Please attach a copy of Termination Letter an
d Termination Package Documents.


Have y
ou had any success in loc
ating new employment

(permanent job or contract work)
?


______________________________________________________________________


If yes
, start date
(and end date if contract)
:
______________________


Please provide a copy of your new employment contract/of
fer letter or contract, if exists
.


P
lease provide p
articulars of your new j
ob
(i.e. contract or permane
nt, j
ob title, salary, benefits)
:


____________________________________________________________________________


_______________________________________
______________
_______________________


____________________________________________
________________________________


_____________________________________________________
_______________________


If no
, p
lease identi
fy what you believe will be
obstacles or
barriers to find
ing

new

work
:


_____________________________
______
_________________________________________


___________________________________
______
___________________________________





W䡅剅H呏TSE乄 Y何删䍏OP䱅呅䐠䙏前


Please email or fax your compl
eted form and documents to Leigh Norton at
leigh.norton@nelligan.ca or f
ax 613
-
364
-
4158
.

Leigh can also
be reached at 613
-
231
-
8216 if
you have any questions

when completing your form
.


Please
remember to
provide copies of
:




P
aystubs as well as T4s for the

past 3 years



J
ob description



E
mployment contract
(s)
/offer letter
(s)



Termination l
etter an
d termination package d
ocuments



A
ny additional information/documents rel
evant to your termination/claim