21-22 Notice of Resignation or Retirement
Please complete this form to provide the District Human Resources office your official written notice of separation of employment.  Your separation will appear on the board personnel report at the next regular board meeting following receipt of this notification.  If any changes are made to your plans, immediately notify Human Resources and your supervisor via email of the change.  If you are retiring and have questions about the date you will retire, please contact either Kathleen Long or Erin Anderson in Human Resources.
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Phone number
Personal email address (non-District)
Type of Separation *
If your separation is a resignation please indicate the reason (i.e. moving, new job, school, etc.)
Please indicate your last day of work. *
MM
/
DD
/
YYYY
Please indicate your date of separation.  (Usually this is the end of your contract or letter of assignment.  If you opt to retire prior to the end of your contract date, please indicate the date here.)
MM
/
DD
/
YYYY
Position type *
Position Title *
Do you wish to work as a substitute after you leave your position? *
Work Location *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Mercer Island School District #400. Report Abuse