HR Office Use Only         Form H – Rev 11.13.14 
                                                                                                                                                                                 _____         Employee       _____         Cust Mgr 
                                                                                                                                                                                 _____         Principal      _____         CTE Coord 
                                                                                       Letter of Resignation                                                                     _____         BT Coord       _____         Dir/Media 
                                                                                                                                                                                 _____         Dir/EC         _____         Dir/Title I 
                                                                                                                                                                                 _____         Dir/ESOL       _____         Dir/SFS 
                                                                                                                                                                                 _____         Dir/Elem       _____         Dir/Tech 
                                                                                                                                                                                 _____         Dir/Middle     _____         Dir/Maint 
                                                                                                                                                                                 _____         Dir/High       _____         Dir/Trans 
               Employee Completes:                                                                                                                                               _____         Retirement     _____         ________ 
                                                                                                                                                                                 _____         __________  _____            Personnel File 
                                                                                                                                                                                  
                                                                                                                                                                                 ___________________________           _______________ 
               Name______________________________________  Last 4 digits of SS#______________                                                                                               Signature                       Date 
                                                                                                                                                                                  
                                                                                                                                                                                  
               Home Address___________________________________________________________________________________________ 
                
               Site_____________________________________  Present Position_________________________________________________ 
                
               I hereby tender my resignation in the Rowan-Salisbury School System to take effect at the close of the day on____________ 
                
               My reasons for resigning – (Check one): 
               _____Retirement                                                         _____Teach in NC charter school _____Interim/Temporary assignment ended                                                                           
               _____Re-Employed retiree resigned                                       _____Teach in private school                              _____Continuing education 
               _____Family obligations                                                 _____Teach in another state                               _____Personal reasons 
               _____Health reasons                                                     _____Moving out of the area                               _____Changing profession 
               _____Dissatisfied with job                                              _____Position ended                                       _____Did not maintain educator’s license 
               _____Transferring to another NC school system or state agency-(name of system)____________________________________ 
               _____Other(please indicate) - ______________________________________________________________________________ 
                
               Additional comments_____________________________________________________________________________________ 
               _______________________________________________________________________________________________________ 
                
              If moving from address given above, please list the future or permanent address where mail may be forwarded to you and the date you plan to move.                        
              Your TAX FORMS will be mailed to this address, unless otherwise notified. 
                
                
              Street Address                                                           City                                       State                        Zip                          Moving Date 
               
                
               Please include personal email address for link to participate in exit survey___________________________________________________________ 
               I understand that my final paycheck will be direct deposited. 
                
               Employee’s Signature____________________________________________________    Date_________________________________ 
                                                      Please present this form to the principal or site supervisor to whom you are assigned. 
                                                                                                                                                                                                                                         
               Principal/Site Supervisor Completes: 
               I acknowledge this resignation with the understanding that his/her last day on payroll will be ________________________________ 
                
               I request advertisement of this position         Yes                                             No                               Employee Code 
                
               Please describe how you would like the vacancy to be listed___________________________________________________________ 
                
               Supervisor’s Signature___________________________________________________    Date_________________________________ 
                                                          Fax/Scan this form to the HR Specialist at the Ellis St. office.  Fax # 704-639-3179 
                                                                                                                            
               Director’s Signature_____________________________________________________    Date_________________________________ 
                                                                                                                                                                                                                                         
               For Human Resources Office Use Only                                                                                               Last day on payroll____________________________ 
                
               HR Specialist___________________________________________________________    Date_________________________________ 
                
               Executive Dir of HR______________________________________________________    Date_________________________________