Human Resources Rehire Eligibility Worksheet

Employee Information

Employee Name Employee ID Department Position at Separation Last Day Worked

Separation Information

Reason for Separation Type of Separation Voluntary Involuntary Eligible for Rehire? Yes No Conditional

Rehire Evaluation Criteria

Criteria	Comments	Meets Criteria?
Performance History		Yes No
Attendance Record		Yes No
Policy Compliance		Yes No
Other (Explain)		Yes No

Additional Notes

HR Reviewer

Name Date