RESIGNATION/RETIREMENT FORM

Human Resources Department
Mt. Diablo Unified School District

1936 Carlotta Drive, Wing A, Concord, CA 94519-1397

Phone (925) 682-8000

Fax (925) 676-4092
RESIGNATION/RETIREMENT FORM
Employee First Name*
Employee Last Name*
Employee ID*
I am a:*

Certificated Employee (e.g. MDEA, MDSPA, Teacher Subs)Classified Employee (e.g. CST, CSEA, TEAMSTERS)
I am submitting this form to:*

Retire from MDUSDResign from MDUSD