Classified Resignation/retirement Form (Page 2 of 2) in pdf

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 (888) 225-7377 approximately three months before

the date of anticipated retirement to request a complete retirement packet. If you are interested in an estimate of

your monthly retirement allowance, CalPERS can provide you with a request form. Once you have submitted the

form to CalPERS, you should receive an estimate in six to eight weeks.

Your resignation date should be your last day of paid service.

For information on medical insurance benefits after retirement, please contact the Los Angeles Unified School

District Employee Benefits Administration at (213) 241-4262. If you receive a monthly retirement allowance, you

may be eligible to have your hospital-medical, dental and vision care insurance paid by the Los Angeles Unified

School District after retirement. You may be able to convert your District-paid life insurance to another program

by contacting the ReliaStar Life Insurance Company at 1-800-955-7736.

If you would like information regarding Social Security benefits, please contact the Social Security Administration

at 1-800-772-1213.

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 non-District candidates), please contact the

Classified Employment Services Branch at (213) 241-6300.

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) 241-4262 for

information.

PC Form 5209 Classified Resignation Form, Revised 09/2013

Classified Resignation/retirement Form Page 2