The undersigned support employee is applying for early retirement pursuant to board policy 413.3, Support Employee Early Retirement. Please complete the following information:
_____________________________________________________ __________________________________
(Full Legal Name of Support Employee) (Social Security Number)
___________________________________ _______________________ _____________________________
(Current Job) (Date of Birth) (Years of Service)
Please specify the date desired for payment of the early retirement benefit and the reason for the date if a date other than _____________ of the year in which the undersigned support employee retires is desired.
_____________________ __________________________________________________________________
(Date) (Reason for date other than_____________________)
Please attach a letter of resignation effective June thirtieth of the year in which the undersigned support employee intends to retire.
The undersigned support employee acknowledges that application and participation in the early retirement plan is entirely voluntary.
The undersigned support employee acknowledges that the school district recommends that the support employee contact legal counsel and the employee’s own personal accountant regarding participation in the early retirement plan.
Should the support employee die prior to full payment of an early retirement benefit, the support employee designates either the following individual as beneficiary or the support employee’s estate.
____ Beneficiary _____ Estate
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Beneficiary
___________________________________________________________________________________________
Beneficiary Address
____________________________________________________ ______________________________________
Support Employee Date
____________________________________________________ ______________________________________
Witness Date