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Forms for Employers

FORM DESCRIPTION REVISED DATE
Certify Service/Salary Certification of employee compensation and hours. 01/2005
Election and Certification to Purchase Absence This form is for the certification and purchasing of service credit for absent time covered under the Uniformed Services Employment and Re-employment Act, and Workers' Compensation. 08/2014
Health Insurance Authorization A retiring member may authorize MPERA to deduct health insurance premiums from their retirement benefit. 10/2011
Name Change If your employee changes their name, please have them complete this form and return it to MPERA. 05/2015
Portal Access Manager Security Agreement Must be completed by new primary users to access the MPERA Online Payroll Reporting System. 06/2016
Retirement Fund Information If an employee terminates, please give them this information regarding their retirement funds. 02/2010
VFCA Roster Printable roster for VFCA Fire Chiefs. 12/2016

 

 

Membership/Beneficiary Designation Cards
Address changes must be done through your employing agency. Contact your HR/payroll office to update your address.
PERS Membership Card/Designation of Beneficiary The Public Employee Retirement System membership card is for new hires and for current PERS members who wish to change their designated beneficiaries.
JRS Membership
/Designation of Beneficiary Cards
The Judges' Retirement System membership card is for new hires and for current JRS members who wish to change their designated beneficiaries.
HPORS Membership
/Designation of Beneficiary Cards
The Highway Patrol Officers' Retirement System membership card is for new hires and for current HPORS members who wish to update their statutory beneficiaries or change their designated beneficiaries.
SRS Membership
/Designation of Beneficiary Cards
The Sheriffs' Retirement System membership card is for new hires and for current SRS members who wish to change their designated beneficiaries.
GWPORS Membership
/Designation of Beneficiary Cards
The Game Wardens' and Peace Officers' Retirement System membership card is for new hires and for current GWPORS members who wish to change their designated beneficiaries.
MPORS Membership
/Designation of Beneficiary Cards
The Municipal Police Officers' Retirement System membership card is for new hires and for current MPORS members who wish to update their statutory beneficiaries or change their designated beneficiaries.
FURS Membership
/Designation of Beneficiary Cards
The Firefighters' Unified Retirement System membership card is for new hires and for current FURS members who wish to update their statutory beneficiaries or change their designated beneficiaries.
VFCA Designation of Beneficiary Cards The Volunteer Firefighters' Compensation Act Designation of Beneficiary card is for volunteer firefighters to name their statutory beneficiaries.

 

 

 

Optional Membership Forms
Public Employees' Retirement System (PERS) New employees in certain positions may elect to join PERS. 05/2012
Firefighters' Unified Retirement System (FURS) New part-paid firefighters may elect to join FURS. 04/2015

 

 

 

Local Elected Official Optional Membership Forms
Current PERS Member A person who is an active member of PERS may elect to participate in PERS as a local elected official. This applies only to positions with less than 960 hours in a calendar year. 10/2014
Retired PERS Member A person who is a retired member of PERS may elect to participate as an active member of PERS as a local elected official. 10/2014
Non-PERS Member A person who is not a member of PERS may elect to participate in PERS as a local elected official. 10/2014

 

 

 

PRINTABLE FORMS
  PERS Plan Choice Options for Non-University Employees  
  PERS Plan Choice Options for University Employees  
  Nearing Retirement Frequently Asked Questions  
  PERS Retirees Returning to Work