The undersigned licensed employee is applying for early retirement pursuant to board policy. Please complete the following information:
______________________________________________________________ _______________________________
(Full Legal Name of Licensed Employee) (Social Security Number)
_______________________________________________________ _________________________ __________________________
(Current Job TItle) (Date of Birth) (Years of Consecutive Service)
Please attach a letter of resignation effective at the end of the current contract year.
The undersigned licensed employee acknowledges that application and participation in the Early Retirement Plan is entirely voluntary.
The undersigned licensed employee acknowledges that the early retirement amount will be paid on January 10 of the school year following the licensed employee’s approval for early retirement.
The undersigned licensed employee acknowledges that the school district recommends that the licensed employee contact legal counsel and the employee’s own personal accountant regarding participation in the Early Retirement Plan.
Should the licensed employee die prior to full payment of an early retirement amount, the licensed employee designates either the following individual as beneficiary or the licensed employee’s estate.
__________ Beneficiary __________ Estate
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Beneficiary
____________________________________________________________________________________________________
Beneficiary Address
______________________________________________________________ _______________________________
Licensed Employee Date
______________________________________________________________ _______________________________
Witness Date
