Code No. 407.6 E 1
LICENSED EMPLOYEE EARLY RETIREMENT APPLICATION
The undersigned licensed employee is applying for early retirement pursuant to board policy 407.6, Licensed Employee Early Retirement.
Please complete the following information:
Full Legal Name of Licensed Employee
Social Security Number
Current Job Title
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 July twentieth of the year in which the undersigned licensed employee retires is desired.
Date
Reason for date other than July twentieth
Please attach a letter of resignation effective June thirtieth of the year in it which the undersigned licensed employee intends to retire.
The undersigned licensed employee acknowledges that application and participation in the early retirement plan is entirely voluntary.
The undersigned licensed employee acknowledges that the school district recommends the licensed employee contact legal counsel regarding participation in the early retirement plan.
Licensed Employee
Date
Witness
Date