When classified staff members in the Los Angeles Unified School District decide it's time to leave their position, whether for retirement, accepting another role within the district, or for personal reasons, PC Form 5209 is the document they'll need to familiarize themselves with. This comprehensive form serves not only as a formal notice of resignation but also guides the employee through the process, specifying the effective date of resignation and providing space for essential personal information. Furthermore, it addresses specific scenarios such as retirement details, including important contacts for pension systems like CalPERS, STRS, and PARS, and instructions for those retiring on how to proceed with getting their benefits. It also contains a crucial clause for those resigning amidst a disciplinary investigation, clarifying their future re-employment eligibility with the district. The form is designed with the employee's needs in mind, providing clear instructions for those wishing to receive their accrued vacation benefits in a lump sum and information on maintaining health insurance through COBRA, among other considerations. For employees planning to retire, it thoughtfully includes guidance on how to secure an estimate of their monthly retirement allowance and the necessary steps for transitioning to retirement status. Additionally, it outlines the possibility of reinstatement within 39 months for those who resign in good standing, making PC Form 5209 a vital tool for navigating the resignation process smoothly and effectively.
| Question | Answer |
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| Form Name | Pc Form 5209 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | PERS, STRS, CalPERS, CalPES |
LOS ANGELES UNIFIED SCHOOL DISTRICT
PERSONNEL COMMISSION
CLASSIFIED STAFF RESIGNATION FORM
I hereby resign from employment with the Los Angeles Unified School District, effective at the end of the work
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Name: |
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Reason for resigning:
I am retiring, effective |
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CalPES
STRS
(If you plan to continue working as a retired substitute, please contact the Classified Employment Transaction Services Branch.)
If you are retiring, the effective date of your resignation should be the day before your retirement date. You may withdraw your resignation within 48 hours after it is submitted.
I have no other LAUSD employment
I am resigning to accept a certificated assignment with LAUSD
(Employees have only 60 days from date of hire to make a retirement system election. Please complete PC Form 100.)
Name of new work location:
I understand that if I am resigning during a disciplinary investigation or process, I will not be eligible for
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If you wish to receive accrued vacation benefits in a lump sum payment, please contact the timekeeper at your work location. If you are a member of the Public Employees’ Retirement System (PERS), please see the attached for additional information. If you are a member of the State Teacher’s Retirement System (STRS), please contact STRS directly at (800)
If you are a member of the Public Agency Retirement System (PARS), please contact PARS directly at (800)
ADMINISTRATIVE ACKNOWLEDGEMENT:
Site Administrator’s Signature
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Employee is to keep a copy. Please send the original to the Classified Employment Transaction Services Branch, |
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P.O. Box 513307, Los Angeles, CA |
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Services Branch, Beaudry Building, 12th Floor. |
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PC Form 5209 Classified Resignation Form, Revised 08/06
INFORMATION FOR CLASSIFIED STAFF PLANNING TO RETIRE
Employees who have at least five years of service credit under California Public Employees’ Retirement System (CALPERS) and who are 50 years of age or older are eligible to receive CALPERS retirement benefits. Employees who have at least five years of service credit under CALPERS and who terminate because of illness or disability may be eligible to receive a disability retirement allowance from CALPERS.
In order to retire, employees must complete this resignation form and a CALPERS application for retirement. Employees planning to retire are advised to call CALPERS at (800)
Your resignation date should be your last day of paid service. The effective date of your retirement should be the day following your resignation.
For information on medical insurance benefits after retirement, please contact the Los Angeles Unified School District Employee Benefits Administration at (213)
If you would like information regarding Social Security benefits, please contact the Social Security Administration at
GENERAL INFORMATION
A permanent employee who resigns in good standing may request to be reinstated up to 39 months after the last day of paid service. Please remember that reinstatement is a privilege and is not guaranteed. (Personnel Commission Rule 771).
If you are currently on a promotional eligibility list and wish to determine whether it is possible to have your name transferred to an open list (a list including District as well as
You may be eligible to continue your health insurance benefits at your own expense under a federal continuance program known as COBRA. Please contact the Employee Benefits Administration at (213)
PC Form 5209 Classified Resignation Form, Revised 08/06