Employer Forms and Publications
Some forms can be submitted online electronically. To submit a form online you will need to have an Employer PERSI web account. Click on the 
icon for the form to login or to register.
Memos to Employers
- Benefits at a Glance
- Required Footnote Disclosure for Audited Fiscal Year 2011 Financial Statements 07/27/2011
Forms
| Forms | Online | |
| RS102 Membership Application - Only for use by Employers that submit paper transmittals. |  |
|
| RS109 Notice of Change in Employment Status | |
|
| RS110 Address change | |
|
| RS115 Beneficiary Designation (for your employees to fill out) | |
|
| RS118 Certification of Police Officer Status (PDF Fill-in Version) | |
|
| RS118A Certification of PERSI Firefighter Status (PDF Fill-in Version) | |
|
| RS130 Certification of City or County Employee's 8-Month Seasonal Status | |
|
| RS132 Certification of Employment of a Retired Member | |
|
| RS132A Certification of Employment of a Retired School Teacher or Administrator | |
|
| RS415 Request for Premium Payments through the ORP Unused Sick Leave Program | |
|
| RS432C Insurance Carrier Certification of Group Insurance | |
|
| RS432R employer Certification of Group Insurance Policy | |
|
| Easy Pay - PERSI's Electronic Payment System | |
|
| PERSI Employers Forms Version Log | |
= external link