How to Request an Evaluation of Employment

Participants & Retirees

The Plan’s Request for Evaluation of Employment Form must be completed in full if you would like a determination from your Area Administrative Office regarding whether the reemployment you are engaged in meets the Plan's definition of Suspendible Employment.

You may also use this form to request an advance determination regarding reemployment you are contemplating in the future. Included with this form is a document explaining the Plan’s Suspension of Benefit Rules.

To help you understand what the Plan considers to be Suspendible Employment, the downloadable form provided below contains the four crucial questions that must be answered before a determination can be reached.

Request for Evaluation of Employment Form

Once you download the form to your computer, you can fill it in, print it, sign and date it, and mail it back to an Area Administrative Office. (You cannot send the form via e-mail.)

Having trouble seeing this PDF form? Click here for more information.