This form will allow you to submit your resignation from Bentonville Public Schools. Please fill out all required information below. When finished, click the SUBMIT FORM button. This will display a formal resignation form that you must print, sign and send to the Human Resource Department.
Submit Date: 7/28/2016
I plan to
Resign (please select one)
The reason for my resignation (if not retiring) is as follows:
My forwarding address is:
At this time I am taking insurance through the Bentonville Public Schools:
I plan on taking a position with another school district within the State of Arkansas:
By initialing here
, I confirm that my resignation is on my own choice, made of my own free will and without being pressured or coerced by any person associated with Bentonville Public Schools or otherwise. Further, I state that I understand that I
am not required to resign now or at any time, and that I may consult with an attorney or any other person of my choosing before resigning.
If you have health insurance with the Bentonville Public Schools, you may be eligible to continue your coverage through COBRA for up to 18 months. You will be responsible for paying the full premium. To see if you qualify, please contact Ruth Newton, Benefits Coordinator, at 479-254-5024 or by email at email@example.com.
To continue other insurance coverage please contact Alexander & Company at 877-823-9442. Any insurance coverage you have with Bentonville Public Schools will end on the last day of the month in which you perform services for the District.
Insurance coverage for an employee who is transferring to another school district in Arkansas at the beginning of a new school year will continue the current year's coverage through August.
Insurance coverage for an employee who is retiring at the end of the school year will continue through July. An employee who retires during the school year and wants to continue health insurance coverage must elect coverage through Arkansas Teacher Retirement (ATRS) or Arkansas Public Employee Retirement.