Retirement Application Request Form - SJCERA Preview on Page 1

Retirement Application Request Form - SJCERA 2026

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  1. Click ‘Get Form’ to open the Retirement Application Request Form in the editor.
  2. Begin by filling out the 'Member Information' section. Enter your full name, employee ID number, email address, birth date, and current address. Ensure all details are accurate for smooth processing.
  3. Provide your daytime phone number and department/employer information. Then, indicate your estimated retirement date, which is typically the day after your termination.
  4. If applicable, complete the 'Spouse/Registered Domestic Partner Information' section. Include their full name, date of marriage or registration, and birth date.
  5. If you are unmarried or unregistered, list a beneficiary's details including their full name, birth date, address, and relationship to you.
  6. Check any applicable boxes regarding Social Security estimates or disability retirement options as outlined on page two of the form.
  7. Finally, sign and date the form at the bottom before submitting it back to SJCERA for processing.

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We welcome those of you who wish to help another person apply for disability, retirement, spouses, or Medicare benefits. You may be a friend, relative, attorney, paralegal, employer, or member of an advocacy group or organization.
The form: confirms your personal details, advises us of the choices you make about retirement, collects information about the total value of your pensions, as required by HM Revenue and Customs.
Renee Ostrander - Chief Executive Officer at SJCERA | LinkedIn.
I declare that: I have docHubed the age 60 and have ceased a paid employment arrangement after the age of 60; or. I have docHubed the age 60 and never again intend to be gainfully employed for 10 or more hours per week; or.

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