"Reduced Workload Program Eligibility and Election Certification Form" - California

Reduced Workload Program Eligibility and Election Certification Form is a legal document that was released by the California Public Employees' Retirement System - a government authority operating within California.

Form Details:

  • The latest edition currently provided by the California Public Employees' Retirement System;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the California Public Employees' Retirement System.

ADVERTISEMENT
ADVERTISEMENT

Download "Reduced Workload Program Eligibility and Election Certification Form" - California

1382 times
Rate (4.4 / 5) 97 votes
California Public Employees’ Retirement System
P.O. Box 942715 Sacramento, CA 94229-2715
888 CalPERS (or 888-225-7377)
TTY: (877) 249-7442 | Fax: (916) 795-4019
www.calpers.ca.gov
Reduced Workload Program Eligibility and Election Certification Form
EMPLOYEE’S NAME (LAST, FIRST, INITIAL)
EMPLOYEE’S CID OR SOCIAL SECURITY NUMBER
BUSINESS PARTNER’S NAME
BUSINESS PARTNER’S CID NUMBER
ELIGIBILITY REQUIREMENTS
YES
NO
1. Is the employee an academic employee for the California State University or a certificated
employee of a school district or an academic employee of a community college district?
2. Does the employee meet the criteria provided in Sections 44922, 87483, or 89516 of the
Education Code?
3. Is the employee’s appointment under the Reduced Workload Program limited to five years of
part-time service?
4. Is the member 70 years of age or less?
Note: If the response to any of the above items is “No,” the employee is not eligible to participate in the Reduced
Workload Program.
REDUCED WORKLOAD PROGRAM
EMPLOYEE’S PERCENTAGE OF
EFFECTIVE DATE
EMPLOYEE’S FULL-TIME SALARY
FULL-TIME
TO BE WORKED
$
%
BUSINESS PARTNER REPRESENTATIVE’S
BUSINESS PARTNER REPRESENTATIVE’S
DATE
NAME & TITLE
SIGNATURE
I hereby certify by submitting this form that the employee mentioned above is eligible to participate in the Reduced
Workload Program as described in Government Code Section 20900 and Education Code Sections 44922, 87483, and
89516.
EMPLOYEE’S NAME
EMPLOYEE’S SIGNATURE
DATE
I hereby elect to participate in the Reduced Workload Program and acknowledge that I will be making retirement
contributions based on my full-time salary.
California Public Employees’ Retirement System
P.O. Box 942715 Sacramento, CA 94229-2715
888 CalPERS (or 888-225-7377)
TTY: (877) 249-7442 | Fax: (916) 795-4019
www.calpers.ca.gov
Reduced Workload Program Eligibility and Election Certification Form
EMPLOYEE’S NAME (LAST, FIRST, INITIAL)
EMPLOYEE’S CID OR SOCIAL SECURITY NUMBER
BUSINESS PARTNER’S NAME
BUSINESS PARTNER’S CID NUMBER
ELIGIBILITY REQUIREMENTS
YES
NO
1. Is the employee an academic employee for the California State University or a certificated
employee of a school district or an academic employee of a community college district?
2. Does the employee meet the criteria provided in Sections 44922, 87483, or 89516 of the
Education Code?
3. Is the employee’s appointment under the Reduced Workload Program limited to five years of
part-time service?
4. Is the member 70 years of age or less?
Note: If the response to any of the above items is “No,” the employee is not eligible to participate in the Reduced
Workload Program.
REDUCED WORKLOAD PROGRAM
EMPLOYEE’S PERCENTAGE OF
EFFECTIVE DATE
EMPLOYEE’S FULL-TIME SALARY
FULL-TIME
TO BE WORKED
$
%
BUSINESS PARTNER REPRESENTATIVE’S
BUSINESS PARTNER REPRESENTATIVE’S
DATE
NAME & TITLE
SIGNATURE
I hereby certify by submitting this form that the employee mentioned above is eligible to participate in the Reduced
Workload Program as described in Government Code Section 20900 and Education Code Sections 44922, 87483, and
89516.
EMPLOYEE’S NAME
EMPLOYEE’S SIGNATURE
DATE
I hereby elect to participate in the Reduced Workload Program and acknowledge that I will be making retirement
contributions based on my full-time salary.