PO Box 40400 | 1010 E Tenth Street | Tucson, AZ 85719
Phone: 520.225.6035 | Fax: 520.798.8683
HR1005 Revised: 10/26/2020
Human Resources | Tucson Unified School District
1010 E. 10th St., Tucson, AZ 85719 | Phone (520) 225-6035 | Fax (520) 798-8683
http://www.tusd1.org/ 1 of 2
Please complete the information below. This form must be received by the Human Resources Office by the established deadline
detailed in your employee agreement. Agreements can be found at: http://www.tusd1.org/Departments/Human-Resources/Employee-
Employee ID Number:
Job Title:
This is to notify the District that I am: (check one)
from my position.
My last day of work will be
(usually the last day of the semester or contract day for all contracted employees).
If you are resigning, please select one of the options below:
Other Employment
Personal Reasons
Other (please provide a brief explanation):
Please initial each sentence and sign below:
_ _ I understand that my actual recorded separation date will be my contract-end date for school-year end
_ _ I understand that any active benefits will terminate on the last day of the month in which I separate. I will be
offered COBRA and be issued a Certificate of Credible Coverage, if applicable, once my separation is
_ _ I understand that it is my responsibility to contact the Arizona State Retirement System (ASRS)
to ensure accurate retirement status and/or eligibility.
_ _ I understand that my separation cannot be rescinded once it has been reported/approved by the Governing Board.
_ _ I understand I may be contacted to complete an exit survey.
Employee Signature:
Personal Email:
Administrator Name/Title:
Administrator Signature:
Note to Site: Please attach this form to the ePAR for processing.
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HR1005 Revised: 10/26/2020
Human Resources | Tucson Unified School District
1010 E. 10th St., Tucson, AZ 85719 | Phone (520) 225-6035 | Fax (520) 798-8683
http://www.tusd1.org/ 2 of 2
Are you separating from the District?
Here are some things that you need to know:
You need to provide a copy of this written notice of intent to separate to your supervisor/administrator
To be eligible for payouts, you need to provide a written notice to Human Resources (HR) by the appropriate deadline
in your employee agreement, as it relates to any sick leave separation benefits, stipend payout requirements, or
contractual obligation. Click Here to View Employee Agreements
You should make arrangements to turn over all work in progress to your supervisor/administrator.
By your last day of work, turn in District equipment, keys, ID badges, library materials etc. to the appropriate issuing
Your “home address of record” is what the District has in Infinite Visions, our ERP System. It is recommended that
you check your address in Self-Serve no later than your last day of work to ensure any final documents and/or W2’s
are sent to the correct address. Please contact HR if address changes later, to ensure delivery of your final annual W-
2 form (Note that the USPS cannot forward W-2s).
If you are also retiring from the ASRS, please contact them directly at (520) 239-3100, as well as Benefits in TUSD-
HR Benefits@TUSD1.org
or 225-6144.
For questions about your final paycheck or anticipated payouts, contact the Payroll Dept. at 225-6250.
Benefits Information
You will receive a COBRA packet to your home address on record 7—10 days after your separation has been
processed in our system.
Please note any deadline dates for continuing insurance coverage(s).
If you have a 403b or 457 account do not close your account(s) until your final check has been processed. Closure
can result in your contribution being rejected and returned to TUSD for refunding to you. Should you wish to withdraw
or move your funds, please contact TSA Consulting Group at 888-796-3786 for transaction routing procedures.
For inquiries about a refund, retirement option or premium benefit option (insurance subsidy), contact the Arizona
State Retirement System (ASRS) directly at (520) 239-3100.
TUSD Contact Phone Numbers
Human Resources: 225-6035
Benefits: 225-6144
Payroll: 225-6150
Returning to Work after Retirement
An ASRS member who terminates employment and begins to receive retirement benefits at normal retirement (age 65,
age 62 with at least 10 years of service credit, or at 80 points) or later may return to employment with an ASRS
employer. However, the ASRS 20/20 rule applies, which limits the retiree to no more than 20 weeks of work at 20 or
more hours per week during the first year of normal retirement. For more detailed information, contact the ASRS at
239-3100 or visit their website at www.azasrs.gov
TUSD ESI Post Retirement Employment Option (PREO) If you are an ASRS Retiree who returns as a contracted
employee through the PREO program, the ASRS 20/20 rule does not apply.