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 attach a letter of resignation effective the last contractual day of the year in 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 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 benefit, the licensed employee designates either the following individual as beneficiary or the licensed employee's estate.
_______ Beneficiary _______ Estate
Beneficiary ____________________________
Beneficiary Address ________________________
Licensed Employee _________________________________ Date ___________
Witness ______________________________________ Date ___________
Approved: 02/13/2023 Reviewed: __________ Revised: __________