Academic Resignation I, , Employee ID Number , do hereby tender my resignation from my position as Department/Discipline: ( only one box full-time contract / part-time academic with the Ventura County Community College District, at: employee) Moorpark College Oxnard College Ventura College This resignation will be effective at the close of business on , my last day of work in a paid status. This resignation is executed by me freely and voluntarily and of my own free will for the reason that: . NOTE: If this resignation is for the purpose of retirement from STRS (State Teachers’ Retirement System) or PERS Retirement System), please be aware that it is your responsibility to submit the (Public Employee’s necessary application forms. Questions may be directed to the Retirement Office of the of Teachers’ Schools Office, , at (805) 383-1993. Resignation for purposes of retirement only intend to continue teaching part-time – Employee Name (Please Print) Employee ID No. Employee Signature: _________________________ _________________ Date: Submit completed form to the office of your Dean and/or appropriate College Administrator who will forward to the Human Resources Department at the Administrative for processing. FOR REVIEW / SIGNATURE: ______________________________ ______________________ College Dean: Date: Chancellor, College President _____________________________ ______________________ and/or Designee Date: If you have health, vision and dental benefits at the time of resignation/ IMPORTANT: retirement, complete the COBRA information on the second page of this form. If you qualify for District-paid retirement benefits, it is NOT necessary to complete the second page. -NOTICE-
Academic Resignation I, , Employee ID Number , do hereby tender my resignation from my position as Department/Discipline: ( only one box full-time contract / part-time academic employee) with the Ventura County Community College District, at: Moorpark College Oxnard College Ventura College This resignation will be effective at the close of business on , my last day of work in a paid status. This resignation is executed by me freely and voluntarily and of my own free will for the reason that: . NOTE: If this resignation is for the purpose of retirement from STRS (State Teachers’ Retirement System) or PERS (Public Employee’s Retirement System), please be aware that it is your responsibility to submit the necessary application forms. Questions may be directed to the Teachers’ Retirement Office of the of Schools Office, , at (805) 383-1993. Resignation for purposes of retirement only – intend to continue teaching part-time Employee Name (Please Print) Employee ID No. Employee Signature: _________________________ Date: _________________ Submit completed form to the office of your Dean and/or appropriate College Administrator who will forward to the Human Resources Department at the Administrative for processing. FOR REVIEW / SIGNATURE: College Dean: ______________________________ Date: ______________________ Chancellor, College President and/or Designee _____________________________ Date: ______________________ IMPORTANT: If you have health, vision and dental benefits at the time of resignation/ retirement, complete the COBRA information on the second page of this form. If you qualify for District-paid retirement benefits, it is NOT necessary to complete the second page. -NOTICE-
academic_resignation_form_fill-in_form_10.11.docx