COUNSELING & PLACEMENT CENTER  
 
 
                  JOB RELEASE 
          
I.  
STUDENT COMPLETES THIS SECTION: 
 
I, ______________________________________, a student worker, request  
 
( ) Resignation   ( ) Change of Job Site   ( )Other ______________      for the following reason(s): 
____________________________________________________________________________________________ 
 
____________________________________________________________________________________________ 
 
 
_________________________ 
 
    ____/___/_____ 
 
__________________ 
Student’s Signature                                                     Date 
 
 
            SSN# 
 
II.  
SUPERVISOR COMPLETES THIS SECTION: 
 
 
As the student’s supervisor, I am notifying the Office of  Student Employment  that the above mentioned 
student is no longer employed under my supervision.  I understand that an immediate replacement is not guaranteed 
by the OSE.  
 
Reasons: 
____________________________________________________________________________________________ 
 
____________________________________________________________________________________________ 
 
_________________________ 
 
 ____/_____/____ 
Department 
 
 
 
Student’s Job End Date 
 
___________________________               _____/_____/____ 
Supervisor’s signature 
 
 
            Date 
 
FOR OFFICE OF STUDENT EMPLOYMENT ONLY: 
 
 
As the Program Specialist, I understand  that the above referred student is no longer employed by the above 
referenced department.  
 
Comments: 
____________________________________________________________________________________________ 
 
____________________________________________________________________________________________ 
 
 
 
 
 
___________________________                _____/_____/____ 
Program Specialist’s signature 
 
            Date 
 
_______________________  
____/____/____ 
Director of Counseling & Placement 
            Date