The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

DuerRNZdjvIm3VsYbdEBBb5NWBeit2b6d5CaoDx

CGM Employee Departure Form

Returning?

A A A

Please complete the survey below if you are leaving your position at the MGH/CGM.

If you are remaining as an MGH/CGM employee but changing your current status to per diem or part time status, please directly email CGM Office Manager (cgm-officemanager@mgb.org)

Thank you!

Helpful Tip - If transferring into a new role within the MGB network, don't forget to update your PPD (Directory) contact information upon starting a new job to reflect accurate email, phone number and department information. The PPD is not automatically updated!

Last Name

* must provide value

First Name

* must provide value

MGH Badge ID Number

* must provide value

Please select employee status type.

* must provide value

MGH Employee, Weekly Paid Hires (Technicians, Technologist, Research Scientists, Lab Managers, Admin Support, Analysts, CRCs, etc.)

MGH Employee, Monthly Professional Hires (MGPO Faculty, Instructors, Research Fellows, etc)

MGH Non-employee/Person of Interest (Student Interns & Research Visitor Collaborators, Research Fellows with external funding/not on MGH payroll).

Bulfinch Temporary Service Hire

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PeopleSoft Job Title

* must provide value

Which CGM Faculty member are you currently working/interning/collaborating with?

* must provide value

What is your desk/office location?

* must provide value

What is your official last day of work?

* must provide value

M-D-Y

Why are you leaving your position in the CGM?

* must provide value

Graduate school

Medical School

Industry Position

Internal transfer to another MGH department

Transfer to a new job within MGB Network

External Employment

Other

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You've selected "Other" as the reason for your resignation - you may use this section to provide any comments/details/information you wish to share.

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Where will you be attending graduate school and what program are you enrolled in?

* must provide value

Where will you be attending Medical school?

* must provide value

Where will you be working in your new industry position?

* must provide value

Where will you be working in your new position?

* must provide value

Please provide a forwarding address (Street, City, State).

* must provide value

Please provide the best phone number to contact you if needed.

* must provide value

Please provide a non-partners email address to contact you if needed.

* must provide value

Are you currently on an MGB Sponsored Visa (J, F, H1B, etc) ?

* must provide value

Yes

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Please enter the type of visa and it's current expiration date.

* must provide value

Please attest that you have completed/will complete the following items:

* must provide value

Turn in MGH ID Badge (to either CGM Central Admin Office or MGH Police & Security Office)

Return Office/Desk Keys to Jim Mull (CGM Central Admin Office)

Clean out assigned CGM Locker

Performed general clean up of your workstation

Please upload your letter of resignation. Letter must include a forwarding address and your last day of employment.

If you need a template, please visit: https://cgm.massgeneral.org/intranet/hr-intranet/will-leaving-cgm/#cgm-departure-form

Upload file

Once the request has been submitted to HR of your term date (last official working day) from MGH, you will no longer have MGH logon, email, building badge access, benefits, etc. Your employee status will be fully terminated after your official last day.

If you believe you will require an extension of your MGH logon, email, or other system access, AFTER your departure date, please discuss with your PI immediately, and contact Karolina Ballester-Pagan (kb583) at least 30 days prior to your departure date.

Please select "YES" as attestation that you understand the above information.

* must provide value

Yes, I attest to understanding the information provided.

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Notes to CGM HR (optional):

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.