BREVARD COUNTY SCHOOL BOARD 2700 Judge Fran Jamieson Way

Viera, FL 32940

RESIGNATION

Date

I hereby resign from the following position

School or Department Assignment

now held by me as an employee of the School Board of Brevard County.

Last work day of service: Month Day Year

Last paid day/term date: Month Day Year

Reason:

I understand that my final salary cannot be released until my file is complete and this resignation has been accepted.

NAME Signature Print or Type ID. No.

Mailing Address

NOTE:

If mailing address should change before the end of the calendar year, you are to submit an address change form so that your W-2 form can be mailed.

HR office use only: Posting: Last Paid Day Last Work Day

FOR IMMEDIATE ADMINISTRATOR:

I have notified HR Employment Specialist for my school/department.

I have contacted the Help Desk in ET to disable all data access for this person.

Evaluation Form is attached.

Link has been provided to Exit Survey

RECOMMEND:

APPROVED DISAPPROVED Principal or Department Head

RECOMMEND:

APPROVED DISAPPROVED Human Resources Services Administrator

Page 1 of Resignation Form PER 9400 024 12/15

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I wish to stay on as a substitute with BPS: Yes _________ No _________

If yes, please contact the Substitute Office within 30 days of your resignation at (321) 633-1000 ext.205.

(Return to Compensation & Benefits Dept.)

Revised 4/17/12

BREVARD COUNTY SCHOOL BOARD 2700 Judge Fran Jamieson Way

Viera, FL 32940

TERMINATION OF BENEFITS (for end-of-year use only by school-based contract employees working less than 12 months)

Name: Date:

Employee ID #

Site #:

By selecting this box, I wish to end my employee benefits as of the last day of the school year. This means that I will receive a payout of my contract salary.

By selecting this box, I wish to maintain my employee benefits through the summer month/months. This means I will receive checks as scheduled through the summer with the benefits deductions automatically taken.

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FOR ADMINISTRATOR ONLY:

Verified by: Site person

Processed by: Benefits Specialist

Date:

Date:

Page 2 of Resignation Form

H:forms/Resignation form page 2.docx

(Return to Human resources with your resignation form)