It’s never too soon to start planning for retirement! Email completed form to HRO@dof.virginia.gov The completion of this form is voluntary and can be submitted up to 12 months in advance. The information allows the Human Resources Office to assist you in the retirement process and further prevent delay of retirement benefits. This form also allows Human Resources to meet state requirements in support of workforce planning strategies that not only support your transition but also affect the agency’s readiness to accomplish its mission.
SECTION 1 – Employee Information
Request Date:	Projected Retirement Date:
Employee Name:	Supervisor Name:
Work Unit/Region:	Department/Work Area:
Email:	Work Phone:
SECTION 2 – Planning
Are you interested in a retirement event?	Yes	No
Comments:
Are you interested in serving as a mentor during your transition?	Yes	No
If yes, interested in mentoring only:	Current Employees	Interns	Apprentices	All
LEAVE ACKNOWLEDGEMENT
Do you intend to use all annual leave balance before your retirement date?	Yes	No
Do you plan to receive a payout for your annual leave up to the authorized maximum?	Yes	No
Do you plan to contribute leave to your 457 Deferred Compensation account?	Yes	No
SECTION 3 – Planning Checklist
To prepare for retirement, be sure to complete the following steps:
Create a myVRS Member On-line Account.
Create monthly benefit estimates through myVRS Benefit Estimator.
Create estimates of your income and expenses using myVRS Retirement Planner.
Sign up for VRS Member Education Courses and/or attend 457 Deferred Compensation Plan educational seminars.
Schedule an appointment with a member of the Human Resources Office.
Schedule an appointment with a VRS Retirement Counselor for individual counseling.
SECTION 4 – Employee Signature
VDOF Retiring Employee Name	VDOF Retiring Employee Signature	Date
For additional information to guide you through the retirement process, the Retirement Readiness Checklist is available at: https://www.varetire.org/pdf/publications/retirement-readiness-checklist.pdf