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 already enrolled in
the PERS or TPAF through other New Jersey Public employment and
is taking an additional position at your employing location covered
by the same retirement system in which he/she is already a member,
then check the "Multiple Enrollment" box.
If the employee is a PERS, TPAF,
or PFRS member but is leaving a position at another employing
location to assume a position at your employing location that
is covered by the same retirement system in which he/she is already
a member, then please check the "Report of Transfer"
box.
Retirement System
Indicate the employee's
retirement system membership by checking the corresponding box.
Social Security Number
Please provide the member’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.
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 Location/Payroll
Number
The member's new employing location
must provide its location number/payroll number.
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.
Hire Date
Please provide employee's date of
hire.
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 membership
in the retirement system 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.