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.
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: _________________________
Please check if you wish to enter into the Substitute Pool
(Our Substitute Coordinator will contact you to discuss this option further.)
(Final W2 statement will be sent to this address)
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
• Complete and submit Separation of Employment from to HR Strand Specialist.
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