Report of Transfer and Multiple
Enrollment Check BoxesType
Check the box that corresponds to
the task you wish to accomplish.
If an employee is already enrolled
in the PERS through other New Jersey public employment and is
taking an additional PERS-covered position at your employing location,
then check the "Multiple Enrollment" box.
If the employee is already a PERS
member but is leaving a position at another employing location
to assume a position at your employing location that is covered
by the PERS, then please check the "Report of Transfer"
Indicate the employee's
PERS membership by checking the corresponding box.
Social Security Number
Please provide the member's Social
Pension Membership Number
Enter the employee's membership number.
Provide the member's address (street,
city, state, zip code).
Daytime Telephone Number
Enter the member's daytime telephone
number, with area code.
Name of Former Employer
The new employer should provide the
name of the former employer, or other employer if it is a multiple
Date of Last Pension Deduction
Reported by Former Employer
The new employer should obtain the
date of last deduction by calling the old employer for the last
date deductions were taken from the member's pay. The
information can usually be obtained with a phone call.
New Employer Location/Payroll
The member's new employing location
must provide its location number/payroll number.
Is New Employing Location a Board of Education?
Please check "yes" or "no"
to indicate whether the new employing location is a board of education.
Employee's TitleNew Position
Please enter the employee's title
in his/her new position.
Please provide employee's date of
Current Annual Base Salary
Give the member's current annual
contractual base salary.
Employee Paid on Ten- or Twelve
Indicate whether the member is paid
on a ten-month or twelve-month basis.
Is Employee Employed by More Than
One Public Agency?
Indicate if the member is employed
at more than one public agency. If yes, please list public agencies
Signature of Certifying Officer,
Date, Telephone Number, Address
After entering the date, telephone
number (with area code and extension), street address, city, county,
state and zip, print out the completed form.
Then, the Certifying Officer of record
must sign the completed form in the space provided. Mail
the completed form to: New Jersey Division of Pensions and Benefits,
PO Box 295, Trenton, NJ 08625-0295.
The Report of Transfer/Multiple
Enrollment Form should be filed with the Division of Pensions
and Benefits within 10 working days of the date employment begins.
The employer should establish that the employees membership
in the retirement system has not expired or been withdrawn. If
the employees membership has expired or been withdrawn,
the employee must complete a new enrollment application. The Division
of Pensions and Benefits will process the Report of Transfer/Multiple
Enrollment Form and will send a Certification of Payroll
Deductions to the new employer advising the employer of the
date pension deductions must begin for the transferring employee.