The City of Tallahassee

* Full Name

Employee ID

Daytime Phone

* Last 4 Digits SS#

Date of Employment

* Email

Department

Buyback Estimates(s) Requested:

Military (*DD214 Required)

Has this service been purchased? Yes
No

Prior City Service

Has this service been purchased? Yes
No

Out-of-City Public Service
Out of City Public Verification Form

Has this service been purchased? Yes
No

(Verification form must be completed and submitted by previous employer.)

Comments:

Submitted by:

How would you like to receive your estimate?

Acknowledgement: I understand that estimates are completed in the order they are received and it may take up to six weeks for me to receive an estimate.

Benefits Estimate Request Form

Estimate(s) Requested: (Check All that apply):

Buyback Estimates(s) Requested: