407.6 - Application for Participation in the Voluntary Early Retirement Program for Full-Time Staff

I hereby submit my formal application for participation in the voluntary early retirement program.  This action is taken in accordance with the Board of Directors Policy No. 407.6 (Voluntary Early Retirement Program for Full-Time Staff).

My resignation from my contract with the District is attached and is made a part of this application.  It is my understanding that this application and resignation will be acted upon simultaneously by the Board of Directors.

 

_________________________________________________   ________________
                        Signature of Employee                                                                      Date

 

_________________________________________________   _________________
                        Signature of Witness                                                                           Date

 

 

ELECTION OF BENEFIT

As a part of my application for the early retirement program, I hereby select the benefit option indicated below.  All benefits are subject to Policy No. 407.6.

                        Date of Birth ___________________

 

II. A.    Benefit for (Certified Teacher,
               Administrator, or Support Staff)                         ___________________

 

             II. B.    Extra year’s Insurance Premium
                              Incentive                                                                 ___________________

 

                        Sum of II. A. and II. B.
                        (Total Incentive Amount)                                  ___________________

 

________         I hereby elect to receive group health insurance benefits in the amount of my benefit value.

 

_________________________________________________   ________________
                        Signature of Employee                                                  Date

 

DESIGNATION OF BENEFICIARY

 

I hereby designate  _________________________________________________________

_____________________________________,  ________________________________,
            street address                                                              city

as my beneficiary.

 

 

 

________________________             ________________________________________
Date                                                                         Signature of Employee

                                     

________________________             ________________________________________
Date                                                                         Signature of Witness Date                                                          

 

 

 

 

RESIGNATION OF CONTINUING CONTRACT

 

I hereby submit my resignation from my position with the Gilmore City-Bradgate Community School District effective at the end of the current year.

 

 

_______________________________             ____________________________________
                        Date                                                                         Signature of Employee

 

 

_______________________________            ____________________________________
                        Date                                                                           Signature of Wittness

 

 

 

 

BOARD OF DIRECTORS ACTION

 

Dear______________________,

The Board of Directors of the Gilmore City-Bradgate Community School District approved the application for voluntary early retirement benefits and accepted the resignation from your position effective at the end of the current school year at their meeting held on ____________________________________.

 

 

 

_______________________________              ____________________________________
                        Date                                                                         Board President

 

_______________________________            ____________________________________
                        Date                                                                         Board Secretary