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 *
Employee First Name *
Employee Last Name *
Employee Middle Name
MCPS Employee ID *
Employee Type *
School / Location *
Position *
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
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 *
Forwarding Address (if different from current)
Effective date for new address
MM
/
DD
/
YYYY
Telephone Number - Primary *
Telephone Number - Secondary
Reason for Separation/Termination *
Accepted Position in
Clear selection
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
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