Fillable Limited Re-Employment of Retired Teachers Tennessee Consolidated Retirement (State of Tennessee)

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Limited Re-Employment of Retired Teachers Tennessee Consolidated Retirement (State of Tennessee)

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TR-0389 (Rev. 2/16) RDA-413
Page 1 of 2
Limited
Re-Employment of
Retired Teachers
Tennessee Consolidated Retirement System
502 Deaderick Street
Nashville, Tennessee 37243-0201
1-800-770-8277 w treasury.tn.gov/tcrs
The school system should complete the necessary certication and forward it to the Commissioner of
Education for approval. Once fully completed, the original form should be submitted to the Tennessee
Consolidated Retirement System with a copy to the Director of Schools to communicate approval or
denial.
SECTION 1. MEMBER INFORMATION
Member ID Last 4 SSN XXX-XX- Date of Birth
Full Name
Mailing Address
City State Zip Code
Email Phone Number
Employing School System Date of Retirement
q
I hereby waive retirement credit for periods of service rendered pursuant to Public Chapter 903,
Acts of 2000 during which benets are received.
Member’s Signature Date
SECTION 2. CONDITIONS OF REEMPLOYMENT AND CERTIFICATION
(To be completed by the agency head or designee.)
YES NO
q
q
Has the retiree been retired for at least one year?
q
q
Does the retiree possess an active, professional teacher’s license?
q
q
Is the salary limited to 85% of system salary based on comparable training and
experience?
q
q
Will tenure be awarded?
q
q
Does the retiree to be appointed have the requisite experience, training and expertise?
q
q
Are other qualied persons available?
Current Endorsements Held:
Subjects and Course Codes of Position to be Filled:
TN License Number: Contract Salary: $
TR-0389 (Rev. 2/16) RDA-413
Page 2 of 2
SECTION 2. CONDITIONS OF REEMPLOYMENT AND CERTIFICATION (continues)
Reason Requesting Permission to Fill Position (check all that apply):
q
Filing a vacant, high-need position.
q
Filing a mission-critical position [core academic, non-instructional leader].
q
The school district has engaged in thorough, responsible, position-specic recruitment efforts
to nd appropriately-endorsed candidates for the position AND has been unsuccessful in those
efforts.
q
The educator being recommended is the most qualied candidate for the position.
Certication: I hereby certify that all conditions to be hired without loss of retirement benets
pursuant to Public Chapter 903, Acts of 2000 have been met. I further certify that
no other qualied person is available for employment in such position. I understand
that beginning July 1, 2001, the increased pension liability will be funded from Basic
Education Program (BEP) allocations or other available funds.
Teacher’s Name
Effective Date through
Agency Head / Designee’s Signature Date
Please forward this form to the Commissioner of Education for certication at:
Tennessee Department of Education
Division of Teachers and Leadership
710 James Robertson Parkway / 12th Floor
Nashville, TN 37243
SECTION 3. CERTIFICATION BY COMMISSIONER OF EDUCATION (select one)
q
Approval: I hereby certify the following school system serves an area that lacks qualied teachers
to ll the following position.
School System: ______________________________________________________
Position: ____________________________________________________________
q
Denial: Qualied teachers who are not retired are available in the area served.
Commissioner’s Signature Date
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Limited Re-Employment of Retired Teachers Tennessee Consolidated Retirement (State of Tennessee)

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Completed 27 January 2021

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