Download resignation/retirement form - Nash

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Nash –Rocky Mount Public Schools
930 Eastern Avenue, Nashville, NC 27856
(252) 459-5220 (252) 459-6404
RESIGNATION / RETIREMENT FORM
This form is to be used when an employee wishes to resign or retire. Employees may attach a personal
letter to this form if they desire. Please submit the completed form to the Personnel Department.
Name:
Social Security #:
-
-
Address:
Street
City
Position:
State
Zip
ext. zip.
School / Department:
Teaching Status: (check appropriate spaces)
Career
Probationary
Provisional
Special Permit
Other
ILT
1 2 3
Lateral Entry
1
2
3
4
5
Type of Separation (check one):
Resignation
Retirement
Effective at the close of the day on :
Reason for Separation (check one):
Family Responsibility
Teach Elsewhere
Health Reasons
Further Education
Relocating
Exit Profession
Job Dissatisfaction
Retirement
Employment in Non-Teaching Position
Other: (Other additional reasons require detailed explanation)
Are you transferring to an LEA, County, or State Agency?
Yes
No
Signature of Employee
Signature of Principal/Supervisor
Date
Date
Date received by Personnel Officer:
Form_resignation_retirement.doc
Revised: 3/2000
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