F00036 Termination of G5 Domestic Employee 

Instructions:

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Information on Completing the Form

1) Return all pages of this form to HR Operations (Select one transmittal format, and submit only once):

a.  E-mail at hroperations@worldbank.org        

b.  Fax +1 (202) 522-7026

Need Help? 

If you are experiencing any issues, please contact HR Operations via email: hroperations@worldbank.org  or phone 202-473-2222 or 5220+32222.

Revision 25 Apr 2023

Staff Member's Information

Staff Name*

UPI:*

G5 Domestic Employee's Information

I hereby confirm that the following G5 domestic employee has left my household:

Last Name:*

First Name:*

Date his / her employment ended ( M/D/YY):*

1. Is the G5 domestic employee listed above transferring to a different employer?

1. Has the G5 domestic employee listed above left the United States?*

2. If Yes above: Did you provide the G5 domestic employee listed above with transportation from the U.S. to his / her home country, per section 2, para. 11 of the G5 Code of Conduct?

3. Please provide domestic employee's destination. This information is now mandatory for reporting G5 Terminations to the State Department.*

Comments

Certification and Signature

I certify that I have complied with the G5 Contract and Code of Conduct*

Staff member's signature:

Date

Initiate a G5 termination request through myHR Self-service and upload this form.

After filling this document, you must sign and date it before returning this document to the World Bank Group. Please ensure ALL information in the submission form is complete and accurate before printing the form. This will generate your form(s) as a PDF file. Review the file for accuracy and completeness. If there is an error, please start a new form.