Irrevocable Election to Retire from Eastern Illinois University
Employee Name (Print): Employee E #:
Covered Bargaining Agreement: Department:
Termination/Retirement Date (mm/dd/yyyy): Date SURS Annuity Begins (mm/dd/yyyy):
Pay Period End Date of 1
st
sick leave
Buy-out payment (mm/dd/yyyy):
Number of sick leave days/hours applied to
1
st
sick leave buy-out payment:
Pay Period End Date of 2
nd
sick leave
buy-out payment (mm/dd/yyyy):
Number of sick leave days/hours applied to
2
nd
sick leave buy-out payment:
The following conditions apply to employees exercising the Irrevocable Election to Retire:
1. Retirement from Eastern Illinois University begins on the termination/retirement date indicated above.
2. All payments for unused sick leave will be reported as earnings to SURS. Earnings, as defined by SURS, are assessed
employee retirement contributions. Payments for sick leave will have employee retirement contributions withheld.
3. Compensation for qualifying unused sick leave will be paid on the pay dates specified by the employee or the final paycheck
from Eastern Illinois University if the employee specifies no pay dates above.
4. For employees electing two sick leave buy-out payments (Unit B, Annually Contracted Faculty, are limited to one terminal
buy-out payment), the payments must be in two different SURS academic years (September 1-August 31) of the four FRE
years as determined by SURS.
5. The Irrevocable Election to Retire must be filed in the Provost Office (faculty) or the Employment Office (Civil Service) no
later than 45 days prior to the first sick leave buy-out payment.
6. The sick leave payment will be calculated based upon the balance of qualifying, unused, payable sick leave days and the
employees salary at the time of payment.
I hereby certify that I am eligible to make this election under the provisions of my Bargaining Agreement listed above. Attached is a
copy of the pertinent language from your Bargaining Agreement.
I elect the Irrevocable Retirement Option described immediately above:
Employee Signature (required) Date (required)
I met with the employee listed above on / /
(mm/dd/yyyy) to explain payout options and provided the
employee with the EIU Irrevocable Fact Sheet.
Benefits Signature & Date (required)
The irrevocable retirement option is accepted by Eastern Illinois University.
Vice President for Business Affairs Signature & Date (required for Civil Service)
Completed Form Distribution to:
Personnel File: Benefits Office: Budget Office: Provost’s Office: Payroll Office: Employee Copy: Dean or Supervisor Copy: Department/Account Manager
Payable S/L Balance:
As of Date Above:
BENEFITS USE ONLY
