Get Employee Exclusion From Pera Membership - Public Employees ...

Completing the Employee Exclusion From Pera Membership form is a crucial step for public employees seeking exclusion from PERA membership. This guide provides clear, step-by-step instructions to help you fill out the form accurately and efficiently online.

Follow the steps to complete the form correctly.

1. Press the ‘Get Form’ button to access the Employee Exclusion From Pera Membership form. This will allow you to open the document and begin filling it out.
2. Fill in your Employee Information. This includes your Social Security number or PERA ID number, first and last name, middle initial, and your address type (permanent, temporary, or mailing). Be sure to provide your complete street address, city, state, zip code, home and business telephone numbers, and email address.
3. Indicate your current marital status by checking the appropriate box: never been married, married, divorced, or widowed. Enter your date of birth and the city and state where you were born.
4. Review the employee exclusion categories located on the reverse side of the form. Check one box that applies to your situation, ensuring you select only one category from the following options: PERA retiree working as a legislative worker, PERA retiree at time of affiliation, etc.
5. Read the Employee Certification section carefully. You are acknowledging that the exclusion you are applying for disqualifies you from certain benefits. Sign and date this section to confirm your understanding.
6. If applicable, your employer will need to complete the Current Employment Information section. This includes the employer's name, mailing address, city, state, zip, date employed, current position, termination date, employer number, and certification details of the authorized signatory. Ensure this section is completed where required.
7. Review all the information entered to ensure accuracy. Once everything is confirmed, you can save the changes, download a copy for your records, print the form, or share it as needed.

Complete your Employee Exclusion From Pera Membership form online today to ensure your exclusion is processed promptly.