Notice of Separation/Termination of Employment from Montgomery County Public Schools
MCPS FORM # 480-4G

Your completion of this form will terminate you from all positions. If there is a position you currently hold in MCPS you wish to keep, please contact the Office of Human Resources and Development to discuss: 301-279-3278.
Email address *
Employee First Name *
Your answer
Employee Last Name *
Your answer
Employee Middle Name
Your answer
MCPS Employee ID *
Your answer
Employee Type *
School / Location *
Your answer
Position *
Your answer
Do you hold more than one position with MCPS? (Examples: coach, substitute, etc) *
Your completion of this form will terminate you from all positions. If there is a position you currently hold in MCPS you wish to keep, please contact the office of human resources and development to discuss: 301-279-3278
Required
Department
Your answer
Last Day of Work *
MM
/
DD
/
YYYY
Resignation/Retirement Effective Date (if on leave may be different than Last Day of Work) *
MM
/
DD
/
YYYY
Current Address *
Your answer
Forwarding Address (if different from current)
Your answer
Effective date for new address
MM
/
DD
/
YYYY
Telephone Number - Primary *
Your answer
Telephone Number - Secondary
Your answer
Reason for Separation/Termination *
Accepted Position in
I will comply with checkout procedures at my school/office and will return all MCPS property. I understand that my electronic submission of this form and my check in the box at the end of this paragraph is intended to be, constitutes and is equivalent of my personal signature. *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Montgomery County Public Schools. Report Abuse