Certification forms

Certification forms

138 Certification of Out-of-State Teaching Service

201 Certification of Individual Contract (CIC)

If a school employee who is working under a personal contract applies for retirement, PERS may send you this form to gather more information about the employee’s contract.
Instructions for filling out a CIC form.

550 Certification of Out-of-State Police Officer

561 Oregon Public Service Retirement Plan (OPSRP) Certification of 911 Operator Service

621 Certification of Non-Participating Oregon PERS Employer for Police or Firefighter

649 Certification of Seasonal Service

679 Workers' Compensation Certification

720 Release Time Certification

779 Employee Leave Without Pay (LWOP) Certification

General instructions

Instructions for filling out and submitting a form.