Form 4049A PDF Details

Navigating the transition from employment at Broward County Public Schools requires thorough understanding and completion of the 4049A form, a critical document that manages the separation process whether it's for resignation or retirement. This form, specifically designed for employees of Broward County Public Schools, marks a significant step in formalizing one's decision to leave the district, ensuring that the separation is recognized officially by the administrative body. Upon deciding to resign, the form must be attached to the Separation of Employment iForm, streamlining the employee’s exit. Conversely, employees looking to retire will engage with the Benefits Department, which takes an active role in facilitating their departure, further eliminating the need for direct action from the location or HRIS on the employee's part. The form captures essential details like the type of employment—whether instructional or non-instructional, along with personal information, and the effective date of separation or retirement. Crucially, it also includes sections where the employee must specify the primary reason for their departure, ranging from job opportunities outside the district to personal reasons and beyond. It even allows instructional employees to detail their future employment plans, if any. Completing this form is not merely a procedural step; it is a comprehensive way for employees to communicate their departure, ensuring that their last paycheck is processed correctly and that their reasons for leaving are documented, paving the way for a smooth transition out of Broward County Public Schools.

QuestionAnswer
Form NameForm 4049A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names2010, NONINSTRUCTIONAL, broward schools seperation of employment iform, INSTRUCTIONAL

Form Preview Example

REFERENCE NUMBER:

SEPARATION OF EMPLOYMENT (RESIGNATION) AND RETIREMENT FORM

CHOOSE ONE: RESIGNATION RETIREMENT

COMPLETE IF RESIGNING OR RETIRING FROM BROWARD COUNTY PUBLIC SCHOOLS

THIS ACTION TERMINATES THE EMPLOYEE FROM THE DISTRICT.

•If the employee is resigning from Broward County Public Schools, attach this form to the Separation of Employment iForm.

•If the employee is retiring, the employee must meet with the Benefits Department. The Benefits Department will forward this form to the location and HRIS. No action is required by the location.

EMPLOYEE INFORMATION

TYPE OF EMPLOYEE:

INSTRUCTIONAL

NONINSTRUCTIONAL

 

 

 

 

 

 

 

 

 

LAST NAME

 

 

FIRST NAME

MI

 

 

 

SAP PERSONNEL NUMBER

 

 

 

 

 

 

 

LOCATION #

 

LOCATION NAME

 

 

 

POSITION TITLE

EFFECTIVE DATE OF SEPARATION/RETIREMENT FROM BROWARD COUNTY PUBLIC SCHOOLS

(THIS IS THE FIRST DAY YOU ARE NO LONGER EMPLOYED BY SBBC):

ACCESS ESS TO VERIFY/UPDATE YOUR PERMANENT ADDRESS. YOUR LAST PAYCHECK WILL BE MAILED TO YOUR PERMANENT ADDRESS.

Indicate the PRIMARY reason for your voluntary separation (choose one):

 

Accepted a job not in another School District (51/C/M)

 

Non-job connected due to medical reasons

 

Accepted a job in another Florida School District (49/B/M)

 

(61/E/M)

 

Accepted a job in another School District outside of Florida

 

Military (70/E/M)

 

(50/L/M)

 

 

 

 

 

Personal (44/E/F)

 

Dissatisfied with Pay (43/D/A)

 

 

 

 

 

Relocation (46/E/H)

 

Dissatisfied with Working Conditions (48/D/D)

 

Retirement (30/A/I) ________________________

 

Family Obligation (42/E/F)

 

 

 

 

 

Retirement/Disability (31/A/I) ________________

 

Inadequate Benefits (52/E/K)

 

 

 

 

 

Returned to School (47/E/G)

 

Lack of Opportunity for Advancement (X/E/B)

 

Resigned in Lieu of Termination During

 

 

 

 

 

 

 

 

 

 

 

Probationary Period (07/N/E)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please rate your level of satisfaction in the following areas

(1 = least satisfied, 5 = most satisfied)

Salary

 

Benefits

Work Environment

Training/Orientation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Administrative Support

 

District Support

 

 

 

 

 

 

Additional Information to be Completed by Instructional Employees:

Accepted another teaching position:

Accepted a position other than teaching or the

 

At a non-public school within the District (A)__________

field of education:

 

Within another district in Florida (B) _____________

 

Within another District in Florida (H)

 

Outside the State of Florida(C) ____________________

 

Outside the State of Florida (I)

Accepted another position in the field of education:

Not Applicable

 

Within another district in Florida (E) _____________

 

Declines to disclose future plans (Y)

 

Outside the state of Florida(F) ____________________

 

Has not accepted employment elsewhere (Z)

 

 

 

 

 

 

 

 

 

Employee’s Signature:

 

 

 

 

 

Date:

 

 

Form #4049A Revised 11/2010

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Filling out segment 1 of INSTRUCTIONAL

2. Once your current task is complete, take the next step – fill out all of these fields - Indicate the PRIMARY reason for, cid Accepted a job not in another, cid Dissatisfied with Pay DA cid, cid Nonjob connected due to, cid Military EM cid Personal EF, Probationary Period NE, Benefits, Please rate your level of, TrainingOrientation, Work Environment District Support, Accepted another teaching position, cid At a nonpublic school within, cid Within another district in, Accepted a position other than, and cid Within another District in with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Step number 2 of filling in INSTRUCTIONAL

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Employees Signature, Form Revised Instructional, and Date inside INSTRUCTIONAL

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