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PER HR ENDING DATE OR SALARIED RATE OF PAY $ POSITION NUMBER PER PAY PERIOD ENDING DATE The salaried ending date must coincide with the end of a biweekly pay period or the rate of pay will be pro-rated by Payroll. PLEASE CHECK THE APPROPRIATE REASON QUIT NO LONGER ELIGIBLE DISMISSED OTHER REASON BANNER ORG # DEPT NAME SUPERVISOR S NAME SUPERVISOR S SIGNATURE DATE.

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