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For schools: How to fill out a Certification of Individual Contract (CIC) form

If an employee at your school who is working under a personal contract applies for retirement, PERS may need more information about the employee’s contract to process their retirement benefits. In this case, PERS will email you a Certification of Individual Contract (CIC) form from PERS.CIC@pers.oregon.gov.

This webpage explains what you need to know to fill out this form correctly.

Tips

  • Make sure your contact information is up to date.

    PERS will email the form to the contact we have on record for your school. This is usually the person assigned the role of employer reporter #1. If no one is assigned that role, we will send it to your web administrator. It is important to keep this role current to avoid delaying the employee’s retirement process.

  • The contract referred to on this form only applies to an individual contract between an employee and the school.

    It does not apply to a collective bargaining agreement negotiated by a union, which is a group contract.

How to fill out section B

Question 1:

screenshot of section B, question 1 

The key question on the form is the first bullet in section B. To answer that question correctly, ask yourself three questions about the employee. If you answer yes to any one of these, then check No for the first bullet.

Are they in a classified, non-teaching position? ☐yes ☐no

Did they work for 12 months (i.e., actually worked, not just paid)? If they did not work during the summer, answer no. ☐yes ☐no

Is their contract part of a collective bargaining agreement (i.e., union-negotiated)? ☐yes ☐no

Question 2:

screenshot of section B, question 2 

Did you check Yes for the first question in section B? If so, check Yes.

Did you check No for the first question in section B? If so, answer either Yes or No, based on the employee’s records. If you don’t know the answer, leave it blank and PERS.Intake.And.Review@pers.oregon.gov will email you if they need an answer to this question.

full form screenshot

Next, electronically sign the form and fill in the date on which you completed the form. Save the form and return it to PERS by e-mailing it to PERS.CIC@pers.oregon.gov or faxing to 503-431-8293.

If you need help filling out the form, email PERS.CIC@pers.oregon.gov.