Employment Update for Re-hires
I understand that it is my responsibility to notify my employer of any changes in the following areas:
Do you need to update your personal information?
Name Change
Address City, State, or Zip Phone number
Education Change Current Employment Tax Status
Criminal Record
Citizenship Status Military Status
Direct Deposit
**Please note that if you elect to change personal information (i.e. name, address, etc) or
are an active member of Teacher's Retirement System of Louisiana, the Human Resources
office will contact you about filling out additional paperwork.
_________________________________________ _____________________
Signature Date
Our Policy
Bossier Parish Community College adheres to a policy of non-discrimination in employment based on race, color, creed, sex, or
national origin. Bossier Parish Community College is an Equal Opportunity/Equal Access Employer.
Retirement Information
Completion of this form is required in compliance with LA Revised Statutes 11:443, 11:707, & 11:737.
___________________________________ ___________________________
Name of Employee Social Security Number
Are you a retiree of ANY retirement system? YES (go to section A)
NO (go to section B)
Section A:
I am a retiree of the _______________________________________________system.
I was in the DROP program prior to retiring. YES NO
I am currently a member of DROP. Date DROP began: _________________________.
Section B:
I am currently a member of the following retirement system:
Teacher's Retirement System of Louisiana System
Louisiana Employees' Retirement System (LASERS)
Social Security
Other (please specify) __________________________________________________________________
**Please note - If hired for a position other than Academic Adjunct - A TRSL Return to
Work Retiree, who has not worked as a Return to Work Retiree prior to July 1, 2010, will
have TRSL Benefits suspended for the duration of employment. In addition, please refer to
TRSL guidelines regarding the 25% earnings cap for RTW Adjunct Instructors.
Please initial as acknowledement of understanding of this statement:
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