Get Notice Of Separation From A Pers-covered Position - State Of Oregon - Oregon

This guide provides clear and detailed instructions for completing the Notice Of Separation From A PERS-Covered Position form online. Whether you are a member separating from your position or an employer assisting in this process, these steps will help ensure accurate and efficient completion of the form.

Follow the steps to accurately complete the form online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the member’s name as it appears on official documents.
3. Input the member’s Social Security number carefully, ensuring accuracy.
4. Provide the member’s mailing address, including city, state, zip code, and country.
5. In Section 4a, check the appropriate box to indicate which tier the member belongs to (Tier One or Tier Two). In Section 4b, check the box for processing type, either Regular or Supplemental.
6. For Section 5, check the box if the reason for separation is known or applicable.
7. Fill in the employer's name, phone number, and PERS-assigned four-digit reporting number in Section 6.
8. Indicate the last day the member actually worked in a PERS-covered position in Section 7.
9. Record the date of the member’s final payment of salary in a PERS-covered position in Section 8.
10. If the member was on paid leave after the last day worked, complete Section 9 by indicating the type of paid leave and the date it ended.
11. If applicable, answer Section 10 regarding any leave of absence without pay. Provide the dates if the answer is yes.
12. In Section 11, the employer must complete lines 11a through 11e regarding sick leave. Enter zero if there are no amounts or if the amounts are unknown.
13. Complete Section 12 with all PERS contributions, distinguishing between pre-tax and after-tax contributions for both the member and employer.
14. Indicate the gross salary paid per records in Section 13.
15. In Section 14, indicate the amount of salary paid during the six-month qualifying period that was not subject to PERS contributions.
16. Calculate and report the difference in Section 15.
17. If applicable, report any lump-sum vacation payoff included in Section 16.
18. For Tier Two members, report the total gross salary earned in Section 17.
19. Ensure that this form is signed by an authorized employer representative in Section 18, and include the date.
20. Once completed, users can save their changes, download, print, or share the form as needed.

Complete your documents online to ensure a smooth transition!