C: Payroll
SOE RV 7/2020
Separation of Employment
My signature below confirms that I am resigning/retiring from my position with the Auburn School District, and
understand the impact to my pay and benefits and that the dates submitted are final and cannot be changed.
Signature: Date:
Notification of:
Resignation – Separation Date: _________________________ Position: _________________________
Please check primary reason(s) for your resignation:
Retiring and Collecting Monthly Pension – Retirement/Separation Date: _________________________
Retiring and Deferring Monthly Pension – Separation Date: _________________________
Resignation from Extra Assignment Only - Effective Date: _________________________
Additional Information:
Please check if you wish to enter into the Substitute Pool
(Our Substitute Coordinator will contact you to discuss this option further.)
Employee Name:___________________________________
Building/Dept:______________________________
____________________________________________________________________________________
(Final W2 statement will be sent to this address)
Phone Number:____________________________________
Personal Email:______________________________
Position with another WA District: ________________________
Other (Please Explain): _________________________________
FOR DISTRICT OFFICE USE ONLY
HR Approval: _______________________________________ Date: _________________________
• Health benefits will end the last day of the month of your employment separation date.
• Call the ASD Payroll Department at 253-931-4925 if you have questions regarding your final paycheck.
• If retiring, call DRS at 800-547-6657 to confirm eligibility and to discuss impacts to pay and service credit based
on your chosen separation date. Please contact HCA at 800-200-1004 to discuss health benefits eligibility
through PEBB.
• Complete and submit Separation of Employment from to HR Strand Specialist.
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