RETIREMENT INTAKE FORM

RETIREMENT INTAKE FORM

EMPLOYEE ATTESTATION*

Have you verified your eligibility for retirement by either receiving a recent retirement benefit estimate, or having a discussion with Retirement Systems staff?

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PLEASE CONTACT RETIREMENT SYSTEMS

Employee Last Name*

Employee First Name*

EMPLOYEE ID NO.*

Your Employee ID No. is your UltiPro number

PENSION*

DEPARTMENT*

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DIVISION

JOB TITLE

SUPERVSIOR NAME*

SUPERVISOR EMAIL*

TYPE OF RETIREMENT APPLICATION(SELECT ONE)*

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LAST DAY WORKED*

ADDRESS*

CITY AND STATE*

ZIP*

PERSONAL EMAIL ADDRESS*

CELL NUMBER*

EMPLOYEE SERVICES CONSULTANT*

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HRA*

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COMMENTS

TYPE OF RETIREMENT

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