RESIGNATION/RETIREMENT FORM FOR CERTIFIED STAFF

TO:
Board of Education
Brunswick City School District
3643 Center Road
Brunswick, Ohio 44212

Today's Date Today's Date / MM / DD YYYY
Choose Resignation or Retirement:
Please accept my resignation or retirement from my position as:
Building:
Last Work Day: Last Work Day: / MM / DD YYYY
Effective Date of Resignation/Retirement: Effective Date of Resignation/Retirement: / MM / DD YYYY
Reason:
Permanent address for official mail: Permanent address for official mail:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Personal Email
Phone Phone - ### - ### ####
Birth Date: Birth Date: / MM / DD YYYY
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Name Name First Last