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Select Benefits Separation Packets

The forms and packets provided on this page are for use only by Department of Military & Veteran's Affairs employees and designated contacts.  Certain forms are designed specifically for use by the department and should not be duplicated for use by other department employees.

Permanent Full-Time or Part-Time                           Long-Term / Non-Perm
Short-Term / Non-Perm 

Separation Packet for Full-time or Part-time Permanent Employees

NOTE:  All separation packets must be accompanied by the employees letter of resignation and final timesheet(s).

• Request for Personnel Action  

• Employment Clearance Form

• Performance Evaluation  

• PERS Information 

• PERS Refund Election Form  

• Annuity Benefit Election Form (SBS)  

• DCP Benefit Payment or Deferral Election (if applicable)  

• Term leave payoff Tax Option Form  

• Form W-4(Optional)

• "Leaving State Employment" Handbook

• COBRA Health Continuation Enrollment Form for Select Benefits (if chosen)

• EXIT SURVEY  (Password available from Vicki Tomal 465-1334)

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Separation Packet for Long-Term/ Non-Perm Employees

NOTE:  All separation packets must be accompanied by the employees letter of resignation and final timesheet(s).

• Request for Personnel Action  

• Employment Clearance Form

• Performance Evaluation  

• Annuity Benefit Election Form (SBS)  

• Term leave payoff Tax Option Form  

• Form W-4 (Optional)

• "Leaving State Employment" Handbook

• COBRA Health Continuation Enrollment Form for Select Benefits (if chosen)

• EXIT SURVEY (Password available from Vicki Tomal 465-4734)

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Separation Packet for Short-Term Non-Perm 

NOTE:  All separation packets must be accompanied by the employees letter of resignation and final timesheet(s).

• Request for Personnel Action  

• Employment Clearance Form

• Performance Evaluation

• Annuity Benefit Election Form (SBS)  

• Form W-4 (Optional)

• "Leaving State Employment" Handbook

• EXIT SURVEY (Password available from Vicki Tomal 465-4734)

Back to the top

DMVA Division of Administrative Services
12300 Mendenhall Loop Road, Suite 218
Juneau, AK 99801
Phone: (907)465-5645 Fax: (907)465-4605
das@ak-prepared.com

Send mail to webmaster@ak-prepared.com with questions or comments about this website.
Copyright© 2004 DMVA Division of Administrative Services
Last Modified 03/23/2006