Departmental Certificate of Status of Member Claiming Service Prior to Membership Date

Category: #242 | Membership and Service Credit , Application Form , Tier 1 , Tier 2 , Tier 3 , Tier 4 , Tier 6

Document Type: Application Form

Tier Number: Tier 1, Tier 2, Tier 3, Tier 4, Tier 6

File Number: 242

Form #242
In order to process a buy-back application, NYCERS must verify the salary and service history for the period of time the member wants to purchase. This form is to be completed by the agency the member worked for to provide verification of the member’s salary and service. It is not acceptable without the documentation listed on the form.

Departmental Certificate of Status of Member Claiming Service Prior to Membership Date