End of Year Exit Forms - Katy Independent School District of Year Exit Paperwork.pdf · END OF YEAR...

6
INSTRUCTIONS FOR COMPLETING END OF YEAR EXIT PAPERWORK ** DO NOT PRINT DOUBLE SIDED ** USE BLUE OR BLACK INK ONLY 1. EMPLOYEE PAYOFF AND BENEFIT ELECTION FORM • Please read all instructions and choose the appropriate option. • NOTE: For additional questions on this form please contact RISK MANAGEMENT at 281.396.2241. 2. EXIT REPORT FORM • Complete TOP PORTION ONLY. (An accurate mailing and email address is imperative.) 3. CHANGE OF ADDRESS, PHONE NUMBER, STATUS FORM • This form is to be COMPLETED ONLY if there are changes to your address, phone number or status upon exit with Katy ISD. Otherwise, you may disregard this document. Documents should be returned to Human Resources by one of the following ways: • Email to [email protected] • In person at the Education Support Complex Annex • Interoffice mail to Human Resources Department • By mail to 438 FM 1463 Katy, TX 77494 For additional assistance with the exit process, you may contact: • PROFESSIONALS o Tracey Sherrill – 281.396.2351 or [email protected] • PARAPROFESSIONALS & AUXILIARY o Ana Reyes – 281.396.2374 or [email protected]

Transcript of End of Year Exit Forms - Katy Independent School District of Year Exit Paperwork.pdf · END OF YEAR...

Page 1: End of Year Exit Forms - Katy Independent School District of Year Exit Paperwork.pdf · END OF YEAR EXIT PAPERWORK ** DO NOT PRINT DOUBLE SIDED ** USE BLUE OR BLACK INK ONLY . 1.

INSTRUCTIONS FOR COMPLETING END OF YEAR EXIT PAPERWORK

** DO NOT PRINT DOUBLE SIDED ** USE BLUE OR BLACK INK ONLY

1. EMPLOYEE PAYOFF AND BENEFIT ELECTION FORM• Please read all instructions and choose the appropriate option.• NOTE: For additional questions on this form please contact RISK

MANAGEMENT at 281.396.2241.

2. EXIT REPORT FORM• Complete TOP PORTION ONLY. (An accurate mailing and email address

is imperative.)

3. CHANGE OF ADDRESS, PHONE NUMBER, STATUS FORM• This form is to be COMPLETED ONLY if there are changes to your

address, phone number or status upon exit with Katy ISD. Otherwise, youmay disregard this document.

Documents should be returned to Human Resources by one of the following ways: • Email to [email protected]• In person at the Education Support Complex Annex• Interoffice mail to Human Resources Department• By mail to 438 FM 1463 Katy, TX 77494

For additional assistance with the exit process, you may contact:

• PROFESSIONALSo Tracey Sherrill – 281.396.2351 or [email protected]

• PARAPROFESSIONALS & AUXILIARYo Ana Reyes – 281.396.2374 or [email protected]

Page 2: End of Year Exit Forms - Katy Independent School District of Year Exit Paperwork.pdf · END OF YEAR EXIT PAPERWORK ** DO NOT PRINT DOUBLE SIDED ** USE BLUE OR BLACK INK ONLY . 1.

HUMAN RESOURCES DEPARTMENT EMPLOYEE PAYOFF AND BENEFIT ELECTION FORM FOR EMPLOYEES WHO WORK 226 DAYS OR LESS 

 

House Bill 973 entitles school district employees to continue benefits through the summer months of a given 

school year if they resign or retire effective after the last day of instruction. Katy ISD is in compliance with that 

legislation and will continue elected benefits for all employees according to their choice.  

Retiring or resigning employees who work 226 days or less per year but are paid on a 12‐month basis may 

request an early payoff. Katy ISD can grant your request but the district needs to verify your requested payoff 

date and how your benefits are to be handled.  

 

Please choose the date of your final paycheck and when you want to end your benefits in the boxes below 

 

 

 

 

 

 

 

 

 

 

 

 

 

___________________________  ________________    ____________________        Printed Employee Name     Employee Number        Date 

  ___________________________  ________________________        Employee Signature               Position/Title    

 If you have questions regarding HB 973, you may call the KISD Risk Management Department at 281‐396‐2241.  

 

Option 1 

______ NO early payout.  Your final paycheck will be August 15th and your benefits will end August 31st 

OR 

Option 2 

______Receive final paycheck on June 30th.               (If you want to extend your benefits beyond June 30th, all premiums will be deducted from your final paycheck.) 

 

If you choose Option 2, you must also choose one of the following. 

______I choose to end my benefits on June 30th 

______I choose to end my benefits on July 31st 

______I choose to end my benefits on August 31st  

Page 3: End of Year Exit Forms - Katy Independent School District of Year Exit Paperwork.pdf · END OF YEAR EXIT PAPERWORK ** DO NOT PRINT DOUBLE SIDED ** USE BLUE OR BLACK INK ONLY . 1.

��������������� ����������������������������� !�"�����#$%&��!�'(�($ �)*+,-./.�0123�45�)67189:�7;9�199<9<=�>?@ABCD�EF�@GEDH?�CI�EJJK?>>�EDJLCK�MGCD?�DNOP?K�QRSTUS�VUS�WXYZU�[\]R_SS�SRabScdZeS�f�VghTfS�iVc�gScUjTR�Zjkc\TfZjl�mnop�q�rst�us�vwx�yz{|�z}}|~~��s��t��~�����sr||��|��|�{�}|����|z~|�}s���|�|��|}��s����z�u��s��z�u��s��t�z���|~st�}|~��s����s}|~~���������������� ������������ ���� �¡¢��¢£�� ¤��¥¦�§¢�¥©�ª«¬�­«®����°±�²³«®�£���µ�°µ�²¶«®��£����°±���­·�¹�º»»�������¼�°µ���­½­®¹�º»»������¾¿ÀÁÂÃÄÄ�ÅÆÇÈÉÊËÌÄÍ� ÎÉÏÄÍ�>?@ABCD�PF�@GEDH?�CI�>AEAN>� ÐÑQRSTUS�VUS�WVjZU�[\]R_SS�SRaÒScdZeS�f�VghTfS�iVc�gScUjTR�Zjkc\TfZjÓ�mnop�q�rst�us�nmx�yz{|�z}}|~~��s��t��~�����sr||��|��|�{�}|����|z~|�}s���|�|��|}��s��Ôz�u��s��z�u��s��t�z���|~st�}|~��s��Õ�s}|~~��Ö×�ª��������� ������������ ���� �¡¢��¢£�� ¤��¥¦�§¢�¥Ø�ª«¬��­«®���°±�¡���Ù��� Ú�ÛÜÝÞßà� Ú�áâããÜàä� Ú�åÜæçãèàä� Ú�éÜäçêàä�¾¿ÀëÂÃÄÄ�ÅÆÇÈÉÏìíÄÍ� ÎÉÏÄÍ�îïðñò� îóôõ�ö÷ó��õ��ô�����õ�ôó�õ��������÷õ�÷ó��õ���� ó���îóôõ�������õ���ô��������������õ��õ��ó�õ��

Page 4: End of Year Exit Forms - Katy Independent School District of Year Exit Paperwork.pdf · END OF YEAR EXIT PAPERWORK ** DO NOT PRINT DOUBLE SIDED ** USE BLUE OR BLACK INK ONLY . 1.
Page 5: End of Year Exit Forms - Katy Independent School District of Year Exit Paperwork.pdf · END OF YEAR EXIT PAPERWORK ** DO NOT PRINT DOUBLE SIDED ** USE BLUE OR BLACK INK ONLY . 1.

Katy Independent School District

Human Resources Department

Exit Packet - Service Record Request Form (Please print clearly)

Employee Name: _______________________ Campus/Department:___________ KISD Employment Date(s): ______________________

Request Date: _______________ Resign Date: __________________

DOB: _______________ Last 4 SS #: __________________

Contact Phone #: ______________ Email address: __________________

*If you are resigning after the current school year completes, your record will be available approx. mid-July to late August depending on the volume of request.

*If you are resigning mid-year, your record will be available after your last pay check with the district.

Employee: (Official Record) Mailing Address:

_________________________________________

_________________________________________

_________________________________________

New School District: (Scanned to HR Contact) New School District Name: __________________________________ New District HR Contact: __________________________________ New District HR Email Address: __________________________________

Employee Signature: _____________________________________

Service Record Contact: 438 FM 1463 Katy, TX 77494 Phone #: 281-396-2347 [email protected]

mailto:[email protected]
Page 6: End of Year Exit Forms - Katy Independent School District of Year Exit Paperwork.pdf · END OF YEAR EXIT PAPERWORK ** DO NOT PRINT DOUBLE SIDED ** USE BLUE OR BLACK INK ONLY . 1.

������������

�������� � !"#������ � $"%%& ���� �

$�"&"'(�)%%# ���*# +,#%��-"&&�. ���"& %��,��/"���%%# ��0� 1"�2� 3��� � 4"5�

6/,' 7� 8�5&,2 �9:�7� 6 #�,'�&�8;��"&�)%%# ���*5�2�"'<,=�-"&&�. �� '���,��/"�� ��"&0��

>,.�?"�& � �,+��",@A1��5B�� �����:�2�,<�C,#D�

E ��,'�F#�G �H"'(�

8�5&,2 �3"('��B# � �����I�%"("���,J�3,+"�&�3 +B#"�2�7�

KKKLKKL

MMNO�PQR�STUV�TWXYQZT[�\Q]]VZX�Q_�\QZ\V_Z�XSTX�PQR�YS�XQ�aY\R b�c[VTV�\SV\d�SV_Ve�f�g�_Vh_VVZXTXYUV�O_Q]�iR]TZ�jVQR_\V�Yk�\QZXT\X�PQR�T�QQZ�T�lQ mn[Vo�

E ��,'�q�#�� #�"'��",'��w�8�5s,2 �H,&B'��#"s2�# �"(' %ApB"��u�8�5s,2 �&�"%�,q��%B ��,�&�+D�,<�-,#D���8�5s,2 �-���%"��"�� %�F#��"�+,'%B+��,#�,�/ #�(,,%�+�B� �w���/ #��

9�� �5&,2 � s"(".s �q�#�# /"# t� ��v �� ��v ��������E �"# � u�,�

9<�� 5�#��",'�-���H,&B'��#2��-����% pB�� �',�"+ �("H 't� w�v �� u�,�

��������������������� ¡���¢�����£¤¥ $ �/,%����6/,' �1�&&���¦§§©ª«� :�� ��¬�������­�

x<� �5&,2 �-���%"��"�� %�F#��"�+,'%B+��,#�,�/ #�(,,%�+�B� �� ®5&�"'��

B��'�E �,B#+ ��: 5�#�� '��E 5# � '���"H �3"('��B# � :�� �

Employee Section

Human Resources Section


End of Year Retiree Exit Forms of Year Retirement Exit Paperwork.pdf · INSTRUCTIONS FOR COMPLETING END OF YEAR RETIREMENT EXIT PAPERWORK ** DO NOT PRINT DOUBLE SIDED ** USE BLUE

End of Year Retiree Exit Forms of Year Retirement Exit Paperwork.pdf · INSTRUCTIONS FOR COMPLETING END OF YEAR RETIREMENT EXIT PAPERWORK ** DO NOT PRINT DOUBLE SIDED ** USE BLUE

Kentwood Public Schools - Michigan · Exit 79 Exit 81 Exit 43 Exit 44 Exit 80 Exit 78 Exit 15 Exit 77/8 Exit 75 Exit 11 Cascade Township Caledonia Township Byron Township Gaines Township

Kentwood Public Schools - Michigan · Exit 79 Exit 81 Exit 43 Exit 44 Exit 80 Exit 78 Exit 15 Exit 77/8 Exit 75 Exit 11 Cascade Township Caledonia Township Byron Township Gaines Township

RSA CONFERENCE 2015 · * LAST IN, FIRST OUT * LAST IN, FIRST OUT SERVICEE AREA 100 1 5 6 HALL A HALL B ALL C Exit #1 Exit #3 Exit #5 Exit #7 Exit #9 #13 Exit #15 Exit #17 Exit #19

RSA CONFERENCE 2015 · * LAST IN, FIRST OUT * LAST IN, FIRST OUT SERVICEE AREA 100 1 5 6 HALL A HALL B ALL C Exit #1 Exit #3 Exit #5 Exit #7 Exit #9 #13 Exit #15 Exit #17 Exit #19

Three Year Plan for GCSC to Exit Distressed Unit Status

Three Year Plan for GCSC to Exit Distressed Unit Status

M TRIANGLE EXPRESSWAY TOLL S HEDULE Exit 66 - NC … · triangle expressway toll s hedule exit 2 exit 3 exit 66 exit 69 exit 62 exit 59 exit 57 exit 56 exit 54 tolls are 35% less

M TRIANGLE EXPRESSWAY TOLL S HEDULE Exit 66 - NC … · triangle expressway toll s hedule exit 2 exit 3 exit 66 exit 69 exit 62 exit 59 exit 57 exit 56 exit 54 tolls are 35% less

Automatic Vehicle Entry Exit Log - Senior Year Project

Automatic Vehicle Entry Exit Log - Senior Year Project

SO I LP AREN TM - UConn CT ECOcteco.uconn.edu/maps/town/SoilParentMat/SoilParent... · Exit 42 Exit 29A Exit l55 Exite 5A Exit r56 Exit l40 Exit 32B Exit 90 Exit 31 Exitt 59 Exit

SO I LP AREN TM - UConn CT ECOcteco.uconn.edu/maps/town/SoilParentMat/SoilParent... · Exit 42 Exit 29A Exit l55 Exite 5A Exit r56 Exit l40 Exit 32B Exit 90 Exit 31 Exitt 59 Exit

Airport Community School District - Michigan...Exit 29 Exit 28 Exit 20 Exit 8A Exit 21 Exit 2 Exit 18 Exit 5 Exit 26 Ash Township Sumpter Township Brownstown Township London ... Education

Airport Community School District - Michigan...Exit 29 Exit 28 Exit 20 Exit 8A Exit 21 Exit 2 Exit 18 Exit 5 Exit 26 Ash Township Sumpter Township Brownstown Township London ... Education

Channa Paperwork.pdf

Channa Paperwork.pdf

HAND Planning and Executing a Year 15 Exit Strategy

HAND Planning and Executing a Year 15 Exit Strategy

Definitely Needlepoint – Integrated Case Studystevens/cpt106/datafiles... · Web viewSave the completed form letter as End of Year Solution. Exit Word. Exit Access. Figure 9 –

Definitely Needlepoint – Integrated Case Studystevens/cpt106/datafiles... · Web viewSave the completed form letter as End of Year Solution. Exit Word. Exit Access. Figure 9 –

The 2014 U.S. Venture Capital Year in Review: Financing & Exit Analysis

The 2014 U.S. Venture Capital Year in Review: Financing & Exit Analysis

EXIT OPEN EXIT - Indiana

EXIT OPEN EXIT - Indiana

Floor plan - Techno Ind · fire exit fire exit fire exit fire exit fire exit fire exit fire exit fire exit entry service entry exit 18.00 24.00 18.00 service entry 1 14x4 a innova-tive

Floor plan - Techno Ind · fire exit fire exit fire exit fire exit fire exit fire exit fire exit fire exit entry service entry exit 18.00 24.00 18.00 service entry 1 14x4 a innova-tive

MACOMB COUNTY SCHOOL DISTRICTSrichmond.ss7.sharpschool.com/UserFiles/Servers/Server...Exit 236 Exit 235 Exit 69 Exit S234 ExitE 65 Exit 23 Exit 231 Exit 230 Exit 63 Exit 229/28 Exit

MACOMB COUNTY SCHOOL DISTRICTSrichmond.ss7.sharpschool.com/UserFiles/Servers/Server...Exit 236 Exit 235 Exit 69 Exit S234 ExitE 65 Exit 23 Exit 231 Exit 230 Exit 63 Exit 229/28 Exit

Exit Now or Exit Later

Exit Now or Exit Later

2004-2005 Exit Cohort Five-Year Longitudinal Study

2004-2005 Exit Cohort Five-Year Longitudinal Study

CITY OF MISSOULA, MONTANA Audit Exit Conference Year Ended June 30, 2007.

CITY OF MISSOULA, MONTANA Audit Exit Conference Year Ended June 30, 2007.

detroit City School District - Michigan · Exit 16 Exit 225 Exit 59 Exit 15 Exit 224B Exit 58 Exit 224 Exit 14 Exit 223 Exit 57 Exit 222B Exit 222A Exit 13 Exit 56 Exit 222 Exit 222

detroit City School District - Michigan · Exit 16 Exit 225 Exit 59 Exit 15 Exit 224B Exit 58 Exit 224 Exit 14 Exit 223 Exit 57 Exit 222B Exit 222A Exit 13 Exit 56 Exit 222 Exit 222

Application for Pediatric Care at Charleston Chiropractic ...charlestonchirostudio.com/assets/pediatric-paperwork.pdf · Application for Pediatric Care at Charleston Chiropractic

Application for Pediatric Care at Charleston Chiropractic ...charlestonchirostudio.com/assets/pediatric-paperwork.pdf · Application for Pediatric Care at Charleston Chiropractic