08/24/2009 Council Packet - Laserfiche WebLink

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• CITY OF LINO LAKES EARLY RETIREMENT INCENTIVE PROGRAM APPLICATION Name: Position Title: Department Date of Application: ❑ I voluntarily elect to apply for the City of Lino Lakes sponsored early retirement incentive program. I understand that, if approved, the City wilt: 1. Contribute an incentive equivalent to twelve (12) weeks of gross salary at my current rate of pay. This payment will be taxable and paid directly to me; and 2. Deposit ten thousand ($10,000.00) dollars into a Post Employment Health Care Savings Account I will be offered benefits continuation at the point of separation and it will be my responsibility to pay any continued benefits in a timely manner. In return, I understand and agree that I wilt: (1) submit my voluntary resignation in writing with a resignation date that corresponds to the date listed below, and (2) sign the Waiver and Release of Claims form waiving my rights to pursue any legal claim against the City of Lino Lakes, its employees and officers. I agree that if my application for an early retirement is approved by the Director of Administration, I will resign from my employment with the City of Lino Lakes on or before 16 October 2009. ❑ I understand that any vacation or sick leave severance payments will be distributed according to my tabor agreement or, if I am not a member of a bargaining unit, the City's personnel policy and applicable post -employment health care savings contribution requirements. ❑ I have read and understand all the information in the Early Retirement Incentive Program. I understand that once my application is accepted by the City of Lino Lakes, my application cannot be revoked or nullified by me. I further understand that the Director of Administration retains the sole discretion to approve or deny any applications based on the number of applications received, the potential cost savings or lack thereof, an employee's critical skills, or the business needs of the City. Employee signature Date Status of Application: ❑ Approved O Denied Dan Tesch, Director of Administration Date