UNION PACIFIC RAILROAD
MECHANICAL DEPARTMENT RETIREMENT/RESIGNATION FORM
Manager Operations - Houston, Gulf Coast, and South Texas SU
Union Pacific Railroad
7100 Kirkpatrick Blvd.
Houston, TX 77028
EMPLOYEE NAME
EMPLOYEE ID NUMBER
Date of LAST DAY WORKED
- I hereby RETIRE from my position of
Railroad Retirement Annuity due to age and service.
Effective date of RRB retirement is:
in order to apply for
OR
- I hereby RESIGN from my position of _ reason
for the following
Please forward my unpaid vacation for the current year of calendar year of
and in lieu of vacation for the next
Herewith are my UP ID and Blue Flag cards. All other UP Company property has been delivered to my manager.
My permanent home mailing address is:_
Printed Name of Employee
Signature
Witnessed by
ID #