HR Office Use Only Form H – Rev 11.13.14 _____ Employee _____ Cust Mgr _____ Principal _____ CTE Coord _____ BT Coord _____ Dir/Media Letter of _____ Dir/EC _____ Dir/Title I _____ Dir/ESOL _____ Dir/SFS _____ Dir/Elem _____ Dir/Tech _____ Dir/Middle _____ Dir/Maint _____ Dir/High _____ Dir/Trans _____ ______Employee Completes: ______Personnel File

______Name______Last 4 digits of SS#______Signature Date

Home Address______

Site______Present Position______

I hereby tender my resignation in the Rowan-Salisbury School System to take effect at the close of the day on______

My reasons for resigning – (Check one): _____Retirement _____Teach in NC charter school _____Interim/Temporary assignment ended _____Re-Employed retiree resigned _____Teach in private school _____Continuing _____Family obligations _____Teach in another state _____Personal reasons _____Health reasons _____Moving out of the area _____Changing _____Dissatisfied with _____Position ended _____Did not maintain educator’s license _____Transferring to another NC school system or state agency-(name of system)______Other(please indicate) - ______

Additional comments______If moving from address given above, please list the future or permanent address where mail may be forwarded to you and the date you plan to move. Your TAX FORMS will be mailed to this address, unless otherwise notified.

Street Address City State Zip Moving Date

Please include personal email address for link to participate in exit survey______

I understand that my final paycheck will be direct deposited.

Employee’s Signature______Date______Please present this form to the principal or site to whom you are assigned.

Principal/Site Supervisor Completes: I acknowledge this resignation with the understanding that his/her last day on will be ______

I request advertisement of this position Yes No Employee Code

Please describe how you would like the vacancy to be listed______

Supervisor’s Signature______Date______Fax/Scan this form to the HR Specialist at the Ellis St. office. Fax # 704-639-3179

Director’s Signature______Date______

For Human Resources Office Use Only Last day on payroll______

HR Specialist______Date______

Executive Dir of HR______Date______