The NJ Enrollment Application form, identified by its form number EE-0681-0511, is a crucial document for employees in New Jersey seeking to enroll in state-administered pension and benefits plans through the New Jersey Division of Pensions and Benefits. It meticulously gathers applicant information, including personal details, employment history, and eligibility for either the Teachers' Pension and Annuity Fund or the Public Employees' Retirement System. Ensuring accurate and timely submission of this form is paramount for both employees and employers to facilitate membership in the state's pension systems.
Embarking on a new or continued journey in public service within New Jersey necessitates navigating the intricacies of employee benefits, with the NJ Enrollment Application Form playing a pivotal role in this process. This form, document number EE-0681-0511, is a comprehensive gateway for workers aiming to affiliate themselves with the Teachers' Pension and Annuity Fund or the Public Employees' Retirement System. It meticulously collects essential personal and employment information, ranging from basic identification details, such as names and addresses, to more specialized data regarding employment history, certification requirements (especially for education professionals), and employment status, including permanent appointments and potential concurrent public employment. The form also inquires about previous benefits received from New Jersey State-administered or local retirement systems, encapsulating a crucial step for ensuring accurate and lawful enrollment in the state's pension and benefits systems. Moreover, it delves into the specifics of an applicant's position, salary, and work schedule, underpinning the eligibility criteria for enrollment. The employer's certification further amplifies the form's significance, serving as a tangible confirmation of an employee's suitability for the selected retirement system, thus marking a critical checkpoint in the journey towards securing one's future through the robust framework of New Jersey's pension and benefits system.
EE-0681-0511
New Jersey Division of Pensions and Benefits
ENROLLMENT APPLICATION
DO NOT WRITE IN THIS BOX
LOCATION NO.
MEMBERSHIP NO.
APPLICANT INFORMATION: (Please Print or Type and follow the instructions on page 2 of this form)
Select Pension Fund: (Check one)
Teachers' Pension and Annuity Fund
Public Employees' Retirement System
1.Name: ___________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
LastFirst (no nicknames)MiddleMaiden Surname and Surname Used During Previous Membership
2.
Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Street
City
State
Zip Code
3.
Social Security #:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _
4. Gender:
Male
Female
5.
Date of Birth: _____/_____/_____
6. Daytime Phone: ( ______ ) ______—_____________
Month
Day Year
7.Is the applicant receiving a benefit from a New Jersey State-administered or local New Jersey retirement system at this time?
Yes
No (If "Yes", please provide retirement system name) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
EMPLOYER INFORMATION (Please Print or Type):
8.Employer Name: __________________________________________________________________________________________
9. County: ________________________ 10. Location #: ______________ Bureau #: ____________
Payroll #: _____________
If Applicable
State Loc Only
11.Title/Position of Applicant: ___________________________________________________________________________________
12. Is the applicant currently employed by more than one public employer?
No
(If "Yes", please provide name of employer(s))
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
TO BE COMPLETED FOR TPAF APPLICATIONS ONLY
13
(a.) Date Employment Began: _____/_____/_____(Do not include temporary or substitute service)
Month Day
Year
(b.) Does position require a New Jersey State Certificate issued by the State Board of Examiners within the NJ Department of
Education? Yes No
(c.) Does the applicant hold a certification issued by the State Board of Examiners within the NJ Department of Education?
Yes No
(d.) For NJ Department of Education Only: Is the position Unclassified Professional?
TO BE COMPLETED FOR PERS APPLICATIONS ONLY
14
(a.) Date Employment Began: _____/_____/_____
14 (b.) Date of Regular or Permanent Appointment: _____/_____/_____
Month Day Year
Day
(c.) Is applicant considered temporary or provisional?
No 15. Is applicant an elected official?
16. Is the applicant appointed by Special Resolution or Ordinance or by the Governor with Senate confirmation?
17. Has the applicant been awarded a professional services contract?
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
18. Current Annual Base Salary $ ____________________
19.
(Check one)
10-Month Position
12-Month Position
20.Are the work hours fixed at 32 hours (Local) or 35 hours (State) or more per week pursuant to Ch.1, P.L. 2010? Yes No
EMPLOYER CERTIFICATION
21.Name of Employer Representative Completing Application: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
22. Phone Number: ( ______ ) ______—_____________ Ext.: ____________
I certify that this employee and position meets the eligibility criteria for the retirement system as provided by law. I acknowledge that I am subject to penalty for falsifying or permitting to be falsified any record, application, form, or report of the retirement system in an attempt to defraud the system
pursuant to N.J.S.A. 43:3C-15 (Two Signatures Required)
23.___________________________________________________________________ DATE:_____/_____/_____
Signature of Certifying Officer
24.___________________________________________________________________ DATE:_____/_____/_____
Signature of Certifying Officer’s Supervisor
NOTE: IF THIS APPLICATION IS NOT SUBMITTED ON A TIMELY BASIS, A LATE EMPLOYER LIABILITY MAY BE ASSESSED.
ENROLLMENT APPLICATION INSTRUCTIONS
(This application to be completed by enrolling employer)
APPLICANT INFORMATION
1.Name — Enter applicant's full name (last, first, and middle initial; no nicknames). If applicant has a previous membership under a maiden or other name, enter that name in the space provided.
2.Address — Enter applicant's current mailing address.
3. Social Security Number — Enter applicant’s Social Security number.
4. Gender — Indicate applicant's gender.
5.Date of Birth — Enter applicant's date of birth. Proof of age is required at the time of retirement - if available, attach a photocopy of the applicant's proof of age to this application. Do not delay submitting the Enrollment Application if proof of age is not available. (Acceptable proof of age documents include: birth certificate; passport; naturalization or immigration papers; or certain other records, including baptismal records, military records, census records, school or business records, age recorded on marriage licenses, and insurance or children's birth records.)
6.Daytime Phone Number — Enter applicant's daytime phone number and extension (be sure to include the area code).
7.Is the applicant receiving retirement benefits — Indicate if the applicant is receiving a benefit from a New Jersey State-administered retirement system or local New Jersey retirement system, and give the system's name.
EMPLOYER INFORMATION
8. Employer Name — Enter the full employer name.
9. County — Enter county in which the employer resides.
10.Location, Bureau, and Payroll Numbers — Enter the appropriate location, bureau or payroll number, as applicable. This information should be as reported on your quarterly Report of Contributions (ROC).
11.Title/Position of Applicant — Enter title/position of applicant.
12.Multiple Public Employers — Indicate whether this applicant is employed by more than one public employer. If you answer "Yes", please indicate the full name of each employer.
TPAF APPLICANTS ONLY
13.(a.) Date Employment Began — Enter the date on which applicant started employment. Do not include temporary or substitute service.
(b.) New Jersey Certificate Required — Indicate whether the title/position requires a New Jersey State Certificate issued by the State Board of Examiners within the NJ Department of Education.
(c.) Applicant has New Jersey Certificate — Indicate whether the applicant holds a New Jersey Certificate issued by the State Board of Examiners within the NJ Department of Education.
(d.) Unclassified Professional — For positions with the NJ Department of Education, indicate if the position is "Unclassified Professional".
PERS APPLICANTS ONLY
14.(a.) Date Employment Began — Enter the date on which applicant started employment.
(b.) Permanent Appointment Date — Enter the date of the applicant's regular or permanent appointment.
(c.) Temporary or Provisional — Indicate if the applicant is still considered a temporary or provisional employee.
15.Elected Official – indicate whether the applicant is an elected official. On or after July 1, 2007, a newly elected official is ineligible for enrollment in the PERS. (See Fact Sheet #80.)
16.Appointed Official – Indicate whether the applicant is appointed. State appointees are individuals appointed by the Governor, including those requiring the advice and consent of the Senate. Local appointees are individuals appointed by the Governor, including those requiring the advice and consent of the Senate or individuals appointed in a similar manner by the governing body of a local entity (county, municipality, etc.). On or after 7/1/07, a newly appointed official who does not have an existing PERS account is ineligible for enrollment in the PERS. (See Fact Sheet #80.)
17.Professional Services Contract – Indicate whether the individual is working under a professional services contract or providing professional services without benefit of a contract.
18.Base Salary — Enter the annual base salary for the year, that is, the annual salary paid to the employee on the date the Enrollment Application is certified by the employer. Base salary is the contractual salary of the employee. Base salary should not include bonuses, overtime pay, stipends or longevity pay, or sick or vacation time paid in lump sum. Hourly or per diem rates should not be entered.
19.10-12 Month Position — Please indicate whether the position is a 10-month or 12-month position.
20.Hours Worked – Indicate whether the applicant works the requisite number of hours. To be eligible for TPAF or PERS membership, the hours worked by an employee enrolled after May 21, 2010, must be fixed at 35 hours or more per week for State employees to be enrolled in the PERS; 32 hours or more per week for Local Government employees to be enrolled in the PERS; or 32 hours or more per week for State or Local Education employees to be enrolled in the TPAF.
21.Name of Employer Representative Completing Application — Print the name of the human resources representative or other employer representative who completes this Enrollment Application for the applicant.
22.Phone Number — Enter employer telephone number for the person who completed this application (be sure to include the area code and extension).
23.Certifying Officer — The Certifying Officer must sign and date this application. Unsigned applications will be returned.
24.Certifying Officer’s Supervisor — The Certifying Officer’s Supervisor must sign and date this application. Unsigned applications will be returned.
Please Note: The newly enrolled member’s estate will automatically be designated as the beneficiary for any death benefit payable. New mem- bers should register with the Member Benefits Online System (MBOS) to update their beneficiary information online — or submit a paper Designation of Beneficiary form.
Filling out the New Jersey Enrollment Application form is an essential step for individuals starting employment in roles that qualify for participation in state pension funds. This structured application captures vital details regarding the applicant's personal information, employment, and eligibility criteria necessary for enrollment in either the Teachers' Pension and Annuity Fund or the Public Employees' Retirement System. It is crucial for applicants to provide accurate and complete information to avoid potential delays or complications in their pension fund enrollment. The following steps will guide applicants through the process of filling out the form.
Next Steps: Once the form is fully completed and all necessary signatures are obtained, it should be submitted to the appropriate department as instructed by your employer or as indicated on the form. Late submission may result in employer liability. Following submission, it is recommended to register with the Member Benefits Online System (MBOS) to manage your pension account online. Here, you can update your beneficiary information and access various resources and tools relevant to your New Jersey state pension fund membership.
The application allows you to enroll in either the Teachers' Pension and Annuity Fund (TPAF) or the Public Employees' Retirement System (PERS).
To report a change of name or include a maiden name, enter your current name in the designated section and then list any previous names, including your maiden name, in the space provided for "Maiden Surname and Surname Used During Previous Membership."
The application requires the following employment information:
If you are employed by more than one public employer, indicate this by selecting "Yes" and provide the name(s) of your other employer(s).
Yes, proof of date of birth is required, ideally at the time of application. However, if it's not available, don't delay submitting the application. Acceptable documents include a birth certificate, passport, or other official documents as listed on the form.
Eligibility for enrollment in the TPAF or PERS is determined by several factors including:
If you are currently receiving a retirement benefit from another New Jersey state-administered or local retirement system, indicate "Yes" on the application and provide the name of the system.
Elected officials are eligible for enrollment in the PERS only under specific conditions outlined in the application instructions, with different rules applying to newly elected officials after July 1, 2007.
The employer is responsible for certifying that the employee and position meet the eligibility criteria for the retirement system. This includes completing sections of the application, verifying employment details, and submitting the form by the appropriate deadlines.
One common mistake people make when completing the New Jersey Enrollment Application form is not using their full legal name, including the middle initial, and instead inserting nicknames or shortened versions of their name. The form specifically requests the full name, including the maiden surname or any surname used during previous membership if applicable, to ensure accurate processing and to avoid confusion with existing records.
Another frequent error occurs with the address section. Applicants sometimes enter incomplete addresses or fail to update the form with their current mailing address. Accurate and complete address details are crucial for the New Jersey Division of Pensions and Benefits to communicate effectively with applicants regarding their enrollment status and any further requirements or updates.
A significant pitfall involves the section requesting the applicant's Social Security Number (SSN). Some applicants either mistakenly enter incorrect numbers, partial SSN, or leave this section blank. The Social Security Number is a vital identifier used not only for track the applicant's enrollment application but also for integrating their records within the pension system.
Errors related to employment details, specifically the dates of employment, whether the position requires a New Jersey State Certificate, and the applicant's current annual base salary, are also common. Providing inaccurate employment information can affect the applicant's eligibility and enrollment into the correct pension fund. It is important for applicants to verify these details with their employer and ensure they are accurately reflected on the application.
Apart from these specific errors, it's crucial for applicants and employers alike to ensure the form is filled out completely and reviewed thoroughly before submission. Missed signatures or unchecked boxes can lead to delays or require resubmission of the application. Hence, attention to detail throughout the form is paramount.
By avoiding these common mistakes and following the listed recommendations, applicants will have a smoother experience when submitting their enrollment application for the New Jersey Division of Pensions and Benefits.
When preparing to enroll in a New Jersey pension program, it's important to have a clear understanding of all necessary steps and documents. The New Jersey Enrollment Application form is a vital first step, but it's likely you'll need several other forms and documents to complete your enrollment process.
Gathering and completing these documents can be a time-consuming task, but it's essential for ensuring a smooth enrollment process into the New Jersey pension program. Each document plays a crucial role in verifying eligibility, defining benefits, and securing your retirement future. Take the time to thoroughly understand and accurately complete each required form to avoid any delays or issues in your pension enrollment.
The New Jersey Enrollment Application form shares similarities with the Federal W-4 form, which is used for determining taxes to be deducted from an employee’s paycheck. Both documents require personal information such as name, address, Social Security number, and employment details. They are crucial for new hires to complete so that their employment benefits and tax withholdings can be accurately processed.
Another similar document is the I-9 Employment Eligibility Verification form. This form, like the New Jersey Enrollment Application, collects personal and employment information to verify an employee's eligibility to work in the United States. While the I-9 focuses on citizenship and immigration status, both forms are necessary for employment compliance and must be completed when someone is hired.
The enrollment forms for private pension plans or 401(k) retirement savings accounts also resemble the New Jersey Enrollment Application. These documents gather employee details, employment history, and select beneficiaries, just like the state’s form. The primary purpose is to ensure future financial security for the employee, which is a common goal across these forms.
Employee health insurance enrollment forms share a similar function with the New Jersey Enrollment Application by collecting detailed personal and employment information to provide benefits. Both types of forms might ask for information regarding dependents and beneficiary designations to ensure coverage and benefits are accurately recorded and implemented.
The Universal Enrollment Form used in various settings for different types of benefits or services, like daycare, extracurricular programs, or health services, mirrors the New Jersey form in its structure and intent. Although the content may differ, both aim to enroll individuals into a program or system by collecting relevant personal information and preferences.
State-specific disability insurance enrollment forms, similar to New Jersey’s, require detailed personal and occupational information to provide appropriate coverage. These forms often include sections on work history, salary, and benefit choices, emphasizing the protection against income loss due to illness or injury, just as the New Jersey form secures future pension benefits.
Applications for professional licensure or certification can also be paralleled with the New Jersey Enrollment Application. These forms validate an individual's qualifications and personal information to grant professional recognition. The necessity to provide detailed personal, educational, and, occasionally, employment information underlines their similarity.
Lastly, applications for life insurance policies resemble the enrollment application in the detail and scope of information collected, including personal data, employment details, and beneficiary selections. Both sets of documents are fundamental in planning for an individual’s future financial stability and welfare.
Filling out the NJ Enrollment Application form correctly is crucial to ensure a smooth enrollment process into the New Jersey Division of Pensions and Benefits. Here are some dos and don'ts to guide you through the completion of this form:
When navigating the complexities of the NJ Enrollment Application form, several misconceptions often arise. Understanding these can help streamline the process and ensure accurate completion:
"Social Security Number is optional." It's a common misunderstanding that providing your Social Security Number (SSN) is optional. In reality, the SSN is a critical piece of information required for the identification of the applicant within the system.
"Gender inclusion is not considered." Some people believe that gender options are limited and not inclusive. However, the form requests gender information strictly for identification purposes and does not limit itself to traditional binary options in its broader practices.
"You can enroll at any time." There's a misconception that enrollment can happen at any time. Enrollment is subject to eligibility and timing requirements that need to be adhered to, to ensure proper processing and benefits allocation.
"Previous pension data is irrelevant." Some applicants think that their history with other New Jersey State-administered or local New Jersey retirement systems is irrelevant. On the contrary, past pension data can significantly impact eligibility and benefits in the current application.
"The form is only for new employees." Another common misunderstanding is that the form is exclusively for new hires. It is also used for existing employees who are becoming newly eligible for a pension plan or changing their pension plan due to job changes.
"All positions are eligible for enrollment." Not every position qualifies for enrollment in pension funds. Eligibility is based on the type of employment, hours worked, and other criteria outlined by the NJ Division of Pensions and Benefits.
"Personal email addresses are preferable." When supplying contact information, it's often thought that a personal email is best. However, using a work email may be more appropriate for verification and correspondence related to employment and pension benefits.
"Hourly or per diem rates are considered base salary." This is incorrect. The base salary refers to the contractual, regular salary. Hourly rates, bonuses, and other forms of irregular pay are excluded from this calculation.
"Beneficiary designations can wait." A notable misconception is the idea that beneficiary information can be updated at a later time without urgency. It’s crucial to designate beneficiaries as soon as possible to ensure benefits are distributed according to the member's wishes in the event of their death.
Dispelling these misconceptions and approaching the NJ Enrollment Application form with accurate information helps ensure a smooth process for the applicant.
Filling out the New Jersey Enrollment Application for pension and benefits requires attention to detail and accuracy. Here's a guide to help you navigate through the process:
Remember, the information provided on this form sets the groundwork for your pension benefits and must be filled out with thoroughness and precision. Once enrolled, consider registering with the Member Benefits Online System (MBOS) to keep your beneficiary information and other details up to date.
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