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Notice of exclusion from calpers membership 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering your Social Security Number in the designated field. This is crucial for identification purposes.
- Fill in your current name, including last, first, and middle names as required.
- Specify the name of your public agency and department or school district where you are employed.
- Indicate your job or position title clearly to ensure accurate representation of your role.
- If your appointment is temporary, enter the nearest number of whole months expected for the appointment duration.
- Provide the appointment date in the format DD/MM/YYYY.
- Select whether your term of appointment is permanent or temporary and specify if part-time, including the fraction of full time if applicable.
- Review the reasons for exclusion from CalPERS membership listed on the form and ensure you understand which applies to you.
- Finally, sign and date the form at the bottom, ensuring all information is accurate before submission.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2011 | 4.7 Satisfied (26 Votes) |
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Related links
NOTICE OF EXCLUSION FROM CalPERS MEMBERSHIP. 1. SOCIAL SECURITY NUMBER. Your employer has contracted with the California Public Employees Retirement. SystemRead more
Explain the exclusion that applies below: 5. You are an independent contractor. 6. You are a CalPERS retiree and have not reinstated from retirement.Read more