Report of Transfer and Multiple
Enrollment Check Boxes—Type
of Action
Check the box that corresponds
to the task you wish to accomplish.
If the employee is already a PFRS
member but is leaving a position at another employing location
to assume a position at your employing location that is covered
by the PFRS, then please check the "Report of Transfer"
box.
In the case of PFRS members, the
"Report of Transfer" check box is the only choice
possible. PFRS eligible titles are full time positions, so multiple
enrollments are not possible.
Retirement System
Indicate that the
employee is a PFRS member 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.
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 employing location.
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.
Work Hours
Indicate whether the hours worked are fixed at 32 hours for local employees or 35 hours
for State employees, in accordance with Chapter 1, P.L. 2010.
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 dates, telephone
numbers (with area code and extension), street address, city,
county, state, and zip, as requested, print out the completed form.
Then, the Certifying Officer of
record and the Certifying Officer's supervisor 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.