Doe facility usage form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Employee Information' section. Enter your last name, first name, and middle initial in the designated fields. Provide your address, including city, state, and zip code.
3. Input the last four digits of your Social Security Number and your telephone number. Next, specify the state or county agency you retired from and your position title prior to retirement.
4. Indicate your official retirement date using the MM/DD/YYYY format. If applicable, answer whether you have been employed by any Hawaii state or county agency after retirement by selecting 'Yes' or 'No'.
5. If you answered 'Yes', provide the employment dates in month/year format. If 'No', list the dates when you were not employed by a state or county agency.
6. In the 'Retiree Certification' section, read through the certification statement carefully. Sign and date the form at the bottom to confirm that all information is accurate.
7. Finally, fax this completed form along with any required documents to the Office of Human Resources as indicated.

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