Form PERS 022 Verification of Part-Time Hours and Salaries - Alaska

Form PERS022 is a Alaska Department of Administration form also known as the "Verification Of Part-time Hours And Salaries". The latest edition of the form was released in September 1, 2016 and is available for digital filing.

Download an up-to-date Form PERS022 in PDF-format down below or look it up on the Alaska Department of Administration Forms website.

ADVERTISEMENT
FOR OFFICE USE ONLY
Verification of Part-time
Hours and Salaries
Division of Retirement and Benefits
Juneau: (907) 465-4460
Toll-Free: (800) 821-2251
P.O. Box 110203
TDD: (907) 465-2805
alaska.gov/drb
Juneau, AK 99811-0203
Fax: (907) 465-3086
Rep. or Tech. Making Request
Date of Request
Name (Last, First M.I.)
RIN or Last Four of Social Security Number Retiring Date
So that we may calculate the correct employment service and salaries, we need you to verify all part-time hours worked by the above
employee during the calendar years employed. Also, please include all salaries earned per year as indicated.
Year _______
Total Hours
Year _______
Total Hours
Year _______
Total Hours
Year _______
Total Hours
January
January
January
January
February
February
February
February
March
March
March
March
April
April
April
April
May
May
May
May
June
June
June
June
July
July
July
July
August
August
August
August
September
September
September
September
October
October
October
October
November
November
November
November
December
December
December
December
Total Hours
Total Hours
Total Hours
Total Hours
Total Salary
Total Salary
Total Salary
Total Salary
Year _______
Total Hours
Year _______
Total Hours
Year _______
Total Hours
Year _______
Total Hours
January
January
January
January
February
February
February
February
March
March
March
March
April
April
April
April
May
May
May
May
June
June
June
June
July
July
July
July
August
August
August
August
September
September
September
September
October
October
October
October
November
November
November
November
December
December
December
December
Total Hours
Total Hours
Total Hours
Total Hours
Total Salary
Total Salary
Total Salary
Total Salary
Reporting Officer
Employer
Date
PERS022 (Rev. 9/16)
G:/publications/forms/pers/pers022.indd
FOR OFFICE USE ONLY
Verification of Part-time
Hours and Salaries
Division of Retirement and Benefits
Juneau: (907) 465-4460
Toll-Free: (800) 821-2251
P.O. Box 110203
TDD: (907) 465-2805
alaska.gov/drb
Juneau, AK 99811-0203
Fax: (907) 465-3086
Rep. or Tech. Making Request
Date of Request
Name (Last, First M.I.)
RIN or Last Four of Social Security Number Retiring Date
So that we may calculate the correct employment service and salaries, we need you to verify all part-time hours worked by the above
employee during the calendar years employed. Also, please include all salaries earned per year as indicated.
Year _______
Total Hours
Year _______
Total Hours
Year _______
Total Hours
Year _______
Total Hours
January
January
January
January
February
February
February
February
March
March
March
March
April
April
April
April
May
May
May
May
June
June
June
June
July
July
July
July
August
August
August
August
September
September
September
September
October
October
October
October
November
November
November
November
December
December
December
December
Total Hours
Total Hours
Total Hours
Total Hours
Total Salary
Total Salary
Total Salary
Total Salary
Year _______
Total Hours
Year _______
Total Hours
Year _______
Total Hours
Year _______
Total Hours
January
January
January
January
February
February
February
February
March
March
March
March
April
April
April
April
May
May
May
May
June
June
June
June
July
July
July
July
August
August
August
August
September
September
September
September
October
October
October
October
November
November
November
November
December
December
December
December
Total Hours
Total Hours
Total Hours
Total Hours
Total Salary
Total Salary
Total Salary
Total Salary
Reporting Officer
Employer
Date
PERS022 (Rev. 9/16)
G:/publications/forms/pers/pers022.indd

Download Form PERS 022 Verification of Part-Time Hours and Salaries - Alaska

692 times
Rate
4.4(4.4 / 5) 35 votes
ADVERTISEMENT