PureTech Health New Hire / Termination Form.

Please complete this form at least 10 days prior to the start date of the new employee or immediately after a termination. The form response will be sent to the RSM ClientCare. You will be contacted by a member of the ClientCare team to schedule the setup or to review the termination process.

If you need assistance with this form, please contact RSM ClientCare at 866-848-2531 option 1, or clientcare@rsmus.com.

Employee General Information

Employee Full Name

Managers Name

Title

Personal Mobile #

Personal Email Address

Termination Info & Options

Note: If this is an emergency termination, please contact the help desk via phone at 866-848-2531 option 1 immediately following submission of this form.

Terminated users will have the following done to the respective accounts:

AD - Password reset
Email - Password reset & active sessions logged off
Box - Account Suspended
Additional Applications as Application - Password reset

What should be done with the user's emails?

To whom should emails be forwarded or delegated?

How long should emails be forwarded or delegated?

Special notes:

Requester Name New Hire Type:	Request Type Start Date:
New Hire Department Office or Remote? OfficeFully Remote Lab Location Tide StTuftsNone (Office only) In the office at least days per week (1-5).	End Date: Termination Type: For Emergency Terminations, please contact the help desk via phone at 866-848-2531 option 1 immediately following submission of this form.