Report of Transfer and Multiple
Enrollment Check Boxes—Type
of Action
Check the box that corresponds
to the task you wish to accomplish.
If an employee is already enrolled
in the TPAF through other New Jersey public employment and is
taking an additional TPAF-covered position at your employing
location, then check the "Multiple Enrollment" box.
If the employee is already a TPAF
member but is leaving a position at another employing location
to assume a position at your employing location that is covered
by the TPAF, then please check the "Report of Transfer"
box.
Please note:
- In the case of an employee with
membership in another State-administered retirement (PERS, PFRS)
who is leaving employment covered by that retirement system
to take a position covered by the TPAF, please complete an
Interfund Transfer
Form, not a Report of Transfer/Multiple Employment
Form, as well as the PERS/TPAF
Enrollment Application.
- In the case of an employee with
membership in another State-administered retirement system (PERS,
PFRS) who is taking employment covered by the TPAF in addition
to the employment covered by the other State-administered
retirement system, please use a PERS/TPAF
Enrollment Application to enroll the employee in
the TPAF. The employee will be a "dual
member".
Retirement System
Indicate the employee's
TPAF membership by checking the corresponding box.
Social Security Number
Please provide the employee's Social
Security number.
Pension Membership Number
Enter the employee's membership
number.
Member Address
Provide the member's address (street,
city, state, zip code).
Daytime Telephone Number
Enter the member's daytime telephone
number, with area code. Include an extension if applicable.
Name of Former Employer
The new employer should provide
the name of the former employer, or other employer if it is
a multiple enrollment.
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 Name and Location/Payroll
Number
The name and location/payroll number of member's new employing location
must be provided.
Is New Employer a Board of Education?
Please check "yes" or
"no" to indicate whether the new employer is a board
of education.
Employee's Title—New Position
Please enter the employee's title
in his/her new position.
Date Employment Began
Please provide employment start date for the new employee.
Does Position Require a New Jersey State Certificate?
Please check "yes" or
"no" to indicate whether the position requires a New Jersey State Certificate issued by the State Board of Examiners within the NJ Department of Education.
Does the Applicant Hold a Certification?
Please check "yes" or
"no" to indicate whether the applicant holds a certification issued by the State Board of Examiners within the NJ Department of Education.
Is the position Unclassified Professional?
Please check "yes" or
"no" to indicate whether
the position is Unclassified Professional (For NJ Department of Education Only).
Current Annual Base Salary
Give the member's current annual
contractual base salary.
Employee Paid on Ten- or Twelve
Month Basis
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
where employed.
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 employee’s TPAF membership
has not expired or been withdrawn. If the employee’s 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.