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

General instructions

Instructions for filling out and submitting a form.