Follow the steps to fill out the form accurately.

1. To begin, click the ‘Get Form’ button to access the form online.
2. In the form, locate the 'Employee Section.' Here, you need to provide your full name, including first, middle, and last names, as required. Fill in your address in the designated fields comprehensively.
3. Enter your Membership Number and Social Security Number accurately. These identifiers are crucial for processing your request correctly.
4. Specify the date you left public employment for uniformed service. Make sure to input the exact month, day, and year to avoid delays.
5. Provide the name of your former employer to verify your previous employment status. This should be the organization you were employed with before leaving for military service.
6. Indicate the dates of your uniformed service. Input the starting and ending dates, ensuring they are consistent with your military records. Attach any necessary supporting documentation, such as military orders.
7. At the bottom of the Employee Section, sign and date the form to certify the information you've provided is accurate.
8. Next, move to the Employer Certification section. The certifying officer from your former employer will fill this out, including their name, title, and the date of your return to public employment.
9. The certifying officer must also note the pensionable salary you would have earned during your military service. If this is not determinable, they may reference existing salary data from the specified periods.
10. Finally, the Employer Certification must be signed by the certifying officer, confirming eligibility for pension benefits. After filling out all required sections, review the entries for accuracy.
11. Once completed, you can save your changes, download a copy, print, or share the form as necessary.

Complete your documentation online and ensure your eligibility for benefits.