Certificate for Retirement
Page 1 of 1
Name of Retiring Employee:
Current Title of Employee:
Total years of service with LAUSD:
Last Place of Employment:
LAUSD Employment - List all offices/schools and titles held:
Brief description of programs that s/he participated in and/or special recognitions in LAUSD:
Date of event:
Date certificate needed by:
Name and title of person requesting certificate:
Where certificate will be picked up:
Select no more than 1.
Résumé, biography or other additional information:
Just an example.