PC Form 5209 at a glance
What it is: The Los Angeles Unified School District Personnel Commission Classified Resignation/Retirement Form is how an employee resigns from employment with the district.
Who signs: The employee signs the form, and the Site Administrator signs the Administrative Acknowledgement.
A filled-in PC Form 5209 example: a cafeteria worker resigns
How to fill out PC Form 5209, box by box
Your name, address and work location
Enter the Name (Last, First and MI), the Employee No., the Social Security No., the Date of Birth and the Alternate Email (Non-LAUSD).
Enter the Home Address: No. & Street, City, State and Zip Code.
Enter the Job Title and the Name of Work Location.
Resignation and reason for resigning
Enter the day your resignation is effective, at the end of the work day.
Write your reason for resigning.
Retiring from CalPERS or STRS
If you are retiring, mark I am retiring, enter the effective day (First day of retirement) and mark From: CalPERS or STRS.
Your resignation date should be your last day of paid service.
In order to retire, employees must complete this resignation form and a CalPERS application for retirement.
Employees who have at least five years of service credit under California Public Employees' Retirement System and who are 50 years of age or older are eligible to receive CalPERS retirement benefits.
Employees planning to retire are advised to call CalPERS at (888) 225-7377 approximately three months before the date of anticipated retirement to request a complete retirement packet.
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) 228-5453.
If you are a member of the Public Agency Retirement System (PARS), please contact PARS directly at (800) 731-7884.
If you plan to work as a return retiree, please contact Classified Employment Services for more information.
Other LAUSD employment
If you have no other LAUSD employment, mark I have no other LAUSD employment.
If you are resigning to accept a certificated assignment with LAUSD, mark that box, enter the Name of new work location and complete PC Form 100. Employees have only 60 days from the date of hire to make a retirement system election.
Employee signature
I understand that if I am resigning during or in lieu of a disciplinary investigation or process, I will not be eligible for re-employment with LAUSD.
Sign on the Employee Signature line and enter the Date.
Administrative acknowledgement
Under ADMINISTRATIVE ACKNOWLEDGEMENT, the Site Administrator signs on the Site Administrator's Signature line and enters the Title and the Date.
More rules for PC Form 5209
You may withdraw your resignation or retirement within 48 hours of submission to the Personnel Commission.
The employee is to keep a copy and provide a copy to their administrator.
A permanent employee who resigns in good standing may request to be reinstated up to 39 months after the last day of paid service.
Common questions about PC Form 5209
Where do I file it?
Send the form to Classified Employment Services, P.O. Box 513307, Los Angeles, CA 90051-1307 or via email at classifiedpersonnel@lausd.net or via school mail to the Classified Employment Services, Beaudry Building, 12th Floor.
Sources
[1] PC Form 5209 Classified Resignation Form (Revised 03/2025), Los Angeles Unified School District Personnel Commission (the Official source link on this page).