University of Akron
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| | |Employee ID #: | |
| | | | |
|First Name | |Middle Name | |
| | | | |
|Last Name | |Suffix | |
| | |
|Mailing Address |County |
| | | | |
|City, State | |Zip Code | |
| | | | |
|Social Security Number | |First Date on Payroll | |
| | | | |
|Birth Date (mm/dd/yyyy) | |Gender M F | |
| |
|Have you retired through an Ohio public retirement system? YES NO |
| |
|Effective Date of Retirement (mm/dd/yyyy) |
| |
|Type of Benefit [ ] Service Retirement [ ] Disability [ ] ARP |
|Ohio retirement system paying the benefit | |
| | |
|[ ] School Employees Retirement System of Ohio |[ ] Ohio Police & Fire Pension Fund |
| | |
| |[ ] State Highway Patrol Retirement System |
|[ ] State Teachers Retirement System of Ohio | |
| | |
| |[ ] City of Cincinnati Retirement System |
|[ ] Ohio Public Employees Retirement System | |
| | |
|[ ] Alternative Retirement Plan (ARP) | |
Forward to the Payroll Office, zip+6210
For Payroll Office Use Only:
ARP Eligible: Y N Date Reported On Web: ____________________________
-----------------------
STRS
Part-time Faculty New Hire
and Rehired Retiree Notification Form
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