Notice of exclusion from calpers membership 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Social Security Number in the designated field. This is crucial for identification purposes.
3. Fill in your current name, including last, first, and middle names as required.
4. Specify the name of your public agency and department or school district where you are employed.
5. Indicate your job or position title clearly to ensure accurate representation of your role.
6. If your appointment is temporary, enter the nearest number of whole months expected for the appointment duration.
7. Provide the appointment date in the format DD/MM/YYYY.
8. Select whether your term of appointment is permanent or temporary and specify if part-time, including the fraction of full time if applicable.
9. Review the reasons for exclusion from CalPERS membership listed on the form and ensure you understand which applies to you.
10. Finally, sign and date the form at the bottom, ensuring all information is accurate before submission.

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