State of Wisconsin
Department of Military Affairs
State Human Resources Office
DMA-3200 (R. 8/2024)
RESIGNATION / RETIREMENT NOTIC
E
Wis. Admin. Code Ch. ER 21
DISTRIBUTION: Original- employee’s personnel file Page 1 of 3
INSTRUCTIONS: This form should be used for all permanent, project, and limited term employee (LTE) resignations or
retirements. Refer to page 2 of this form for further instructions.
NAME (First, Middle Initial, Last)
CLASSIFICATION/JOB TITLE
PERM, PROJ, LTE
WORK UNIT (Base, Division, Directorate)
LOCATION
PERSONAL EMAIL
MAILING ADDRESS AFTER LEAVING DMA
PERMANENT MAILING ADDRESS FOR
W-2, (if different)
HOME PHONE
LAST DAY EXPECTED IN THE OFFICE
LAST DAY EXPECTED IN PAY STATUS
REASON FOR RESIGNATION
(This information is necessary to ensure benefits and employment records are processed appropriately.)
RETIREMENT
LEAVING STATE SERVICE
MOVEMENT WITHIN DMA
WORK FOR WISCONSIN COURT SYSTEM
WORK FOR WISCONSIN STATE LEGISLATURE
WORK FOR UW SYSTEM
Name of UW
agency
Name of state agency
Effective start date of new position (if applicable):
Employees terminating state service by resignation or retirement who submits notice at least 14 calendar days in
advance, will have the following options for their remaining leave credits (other than sick leave). Please indicate your
Leave Credit Option below. This section is not applicable to LTEs.
Date of resignation/retirement to be extended by
Option B
Remaining leave credits to be paid out in a lump sum.
I acknowledge I am required to return my DMA employee ID/CAC/DBIDS and access card/fob as well as any other DMA property
(such as keys, purchasing card, IT equipment, etc.) to my supervisor on or before my last day in the office.
I acknowledge that anything meeting the definition of “public record” in s.16.61, Wis. Stats. is property of DMA. Unless authorized by
an applicable Records Disposition Authorization (RDA), I may not destroy public records or take DMA’s only copy of a public record.
If I wish to take duplicates of public records with me upon my departure, I must obtain prior approval from my supervisor.
SIGNATURE OF EMPLOYEE
DATE
Note: After an employee submits a resignation letter, neither the employee nor the appointing authority can withdraw,
stop, or change the resignation date or other terms of the resignation except by mutual written agreement. Refer to
Wisconsin Administrative Code, Chapter ER 21
.
ACKNOWLEDGEMENT
We acknowledge receipt of your intent to resign/retire from your position at the Wisconsin Department of Military Affairs.
SIGNATURE OF SUPERVISOR
DATE
SIGNATURE OF HR DIRECTOR (Or Designee)
DATE
Page 2 of 3
INSTRUCTIONS
Employee Instructions:
1. Employee completes the Resignation/Retirement Notice form to notify the Department of Military Affairs of the
upcoming departure. Employees may choose to supplement this completed form with a formal letter of
resignation, but it is not required.
2. Employees who have questions or need assistance calculating earned leave for Options A and B from Page 1,
please reach out to DMAPayroll@widma.gov
.
3. Employee submits page 1 of the form to their supervisor not less than 14 calendar days before the last day
expected to be in office.
4. Employees should notify Human Resources of any address change after their resignation/retirement to ensure
receipt of their W-2.
5. Employees who are retiring must report their last day on payroll to Employee Trust Funds (ETF) in order for them
to administer annuity and benefit options. https://etf.wi.gov/retirement
Supervisor Instructions:
1. Supervisor acknowledges the Resignation/Retirement Notice form by signing and dating the appropriate area.
Supervisors may choose to supplement this completed form with a formal letter of acknowledgement, but it is not
required.
2. Supervisor forwards the form to DMAPayroll@widma.gov
.
3. Supervisor makes plans with the departing employee to collect DMA issued items on or before their last day in the
office.
Payroll/Human Resources Instructions:
1. Payroll ensures the employee’s last day in the office compared to the last day on payroll are accurate.
2. Payroll/HR Director Designee acknowledges the Resignation/Retirement Notice form by signing and dating the
appropriate area.
3. Payroll will forward the final signed copy to the employee and supervisor.
4. Human Resources will upload the final signed Resignation/Retirement Notice form to the employee’s personnel
file.
5. Human Resources will send information on the exit interview process to the employee.
Leave Implications for Employees Retiring or Leaving State Service:
Unless Option A on page 1 is selected, all remaining leave (except for sick leave) will be paid out on the employee’s final
paycheck.
• Vacation and legal holiday hours for the calendar year are prorated based on the actual hours in pay status and
observed holidays. If the employee has used more than the prorated amount of leave, the value of the overused
leave hours will be deducted from the employee’s final paycheck.
• Personal holiday hours for the calendar year may be paid out in a lump sum. Employees who have not
completed six months of their original probation are not entitled to personal holiday hours; the value of any
personal holiday time used will be deducted from the employee’s final paycheck.
• Sabbatical hours can also be paid out in a lump sum to the employee’s Wisconsin Deferred Compensation (WDC)
account with the last paycheck. Contact DMA Payroll in advance to schedule this deduction.
• For employees who are retiring, the Sick Leave Credit Certification will be submitted by DMA Payroll to ETF
following the employee’s last date in paid status, if eligible. Refer to the Sick Leave Credit Conversion Program
brochure https://etf.wi.gov/publications/et4132/direct
f
or additional information regarding eligibility and
calculations.
Page 3 of 3
Limited Term Employees (LTEs) Applying for Unemployment Benefits:
• Limited Term Employees may file an unemployment claim in the first week that employment stops or work hours
are reduced.
• See digital poster for when and how to apply for unemployment benefits (En Español | Txhais lus Hmoob
)
(https://dwd.wi.gov/eworkboard).
• For help call (414) 435-7069 or toll-free (844) 910-3661 during business hours.
Other unemployment resources:
•
Filing Requirements Video (https://www.youtube.com/watch?v=NMwGFvkcO6Y )
•
Information You Need to Apply ( https://dwd.wi.gov/uiben/information-needed.htm)
•
Apply Online ( https://dwd.wi.gov/uiben/apply)
•
More Information and FAQs ( https://dwd.wi.gov/uiben)