Fill - Free fillable RCUHCertificationofComplianceCurrentRCUHEmployee EmploymentofERSRetirantwiththeRCUH RCUHHumanResourcesDepartment (808)9566965/7055 nsakamoto@rcuh.com Act179becamelawonJune28,2010whichamendedChapter88, PDF form

RCUHHumanResourcesDepartment (808)956‐6965/7055 nsakamoto@rcuh.com



RCUHHRFormNo.D‐95a OriginaltobeplacedinEmployee’sRCUHpersonnelfile

January10,2011

RCUHCertificationofCompliance–CurrentRCUHEmployee

EmploymentofERSRetirantwiththeRCUH

Act179becamelawonJune28,2010whichamendedChapter88,HRS–PensionandRetirementSystemsas§88‐

9withaneffectivedateofJanuary1,2011.§88‐9isapplicabletoanycurrentandprospectiv e retirantsofthe

StateofHawaii’sEmployeeRetirementSystem(ERS)whoworksor

planstoworkfortheRCUH.A“retirant”isa

retireeofaStateorCountyagencyreceivingpensionbenefitsfromtheERS.RCUHisaStateagencytherefore,

employmentofERSretirantswith theRCUHissubjectto§88‐9.AnERSretirantmaylegallyworkfortheRCUHif:

(1)he/shesuspendshis/herERSpensionduringhis/her periodof

employmentwiththeRCUHor(2)priorto

his/heremploymentwithRCUHhe/shemusthavehada6consecutivecalendarmonthretirement/break‐in‐

serviceperiodduringwhichtimehe/shedidnotworkforanyStateorCountyagency.

§88‐9(d)(3)(A)(B)states:

(d) Aretirantmaybeemployedwithoutreenrollmentinthesystemandsuffernolossorinterruptionof

benefitsprovidedbythesystemorunderchapter87Aiftheretirantisemployed:

(3) Asapart‐timeortemporaryemployeeexcludedfrommembershipinthesystempursuantto

section88‐43,

asasessionemployeeexcludedfrommembershipinthesystempursuantto

section88‐54.2,asthepresidentandchiefexecutiveofficeroftheHawaiiTourismAuthority

excludedfrommembershipinthesystempursuanttosection201B‐2,orasanyotheremployee

expresslyexcludedbylawfrommembershipin

thesystem;providedthat:

(A) TheretirantwasnotemployedbytheStateoracountyduringthesixcalendarmonths

priortothefirstdayofreemployment;and

(B) NoagreementwasenteredintobetweentheStateoracountyandtheretirant,priorto

theretirementoftheretirant,

forthereturntoworkbytheretirantafterretirement;

CERTIFICATION:Pleasechecktheconditionthatisapplicabletoyou:

1.IamnotanERSRetirantandnotvestedintheState/CountyERS.§88‐9(d)(3)(A)(B)doesnotapplyto

me.

2.IamnotanERSRetirantbutvestedintheState/CountyERS.§88‐9(d)(3)(A)(B)mayapplytome.

3.IamanERSRetirantandIhada6‐consecutivecalendarmon th retirement/break‐in‐serviceperiod

priortomycurrentapplicationforemploymentwiththeRCUH.(YoumustcompleteERSFORM‐209 see

attachment.)SendyourcompletedERSForm209toNelsonSakamoto,DirectorofRCUHHuman

Resources(nsakamoto@rcuh.comorfax(808)956‐5022)beforeyourstartdate.

4.IamanERSRetirantbutIdidnothavea6‐consecutivecalendarmonthretirement/break‐in‐service

periodpriortocurrentapplicationforemploymentwiththeRCUH.(Youmaybeineligiblefor

employmentatthistime.YoumustcontacttheRCUHDirectorofHumanResourcesimmediately.)

IcertifythatIhavereadandacknowledgetheconditionsof§88‐9(d)(3)(A)(B)andIhavecheckedmyapplicable

status.Ifurther

understandcompliancewith§88‐9(d)(3)(A)(B)is aconditionofemploymentwiththeRCUH:

Signature:Date:

PrintName:

Email:Phone:



RCUHFormattedERS‐209

Act179/SLH2010(01012011)

EMPLOYEES’RETIREMENTSYSTEMOFTHESTATEOFHAWAII

201MerchantStreet,Suite1400,Honolulu,Hawaii96813‐2980



RCUH/ERSCERTIFICATIONOFCOMPLIANCEWITH

REQUIREMENTSFOREMPLOYMENTOFARETIRANT

(customizedforRCUHuseonly)



CompletethisformifyoureceivearetirementallowancefromtheEmployees’RetirementSystemoftheStateofHawaii

(ERS)andhavebeenorwillbehiredbytheStateoracountyinapositionthatisexcludedfromERSmembership.



PARTI(TOBECOMPLETEDANDSIGNEDBYTHERETIRANT)

RETIRANTNAME(LAST,FIRST,M.I.)



SOCIALSECURITYNUMBER

XXX‐XX‐

DAYTIMEPHONE



STREETADDRESS RETIREMENTDATE



CITY,STATE,ZIPCODE PREVIOUSDEPARTMENT:__

________________________

PREVIOUSDIVISION:____________________________________



StateofHawaii Countyof___________________

CityandCountyofHonolulu

Iunderstandthat,asanERSretirant,Imustmeettherequirementsforemploymentofaretirant,whicharesummarizedbelow,during

thetimeIamemployedinapositionthatisexcludedfromERSmembership.IfIdonotmeettherequirementsforemploymentofa

retirant,IwillforfeitmyentireretirementallowanceandhealthbenefitsduringtheperiodthatIamemployedbytheRCUHafter

January1,2011.



Ialsounderstandthat,ifIdonotmeettherequirementsforemploymentofaretirant,IwillberequiredtoreimbursetheERSfor:

 Anyretirementallowance

orotherbenefitsIreceiveafterJanuary1,2011whileIamemployedbyRCUH,plus8percent

annualinterest:

 AnyemployeeretirementcontributionsthatshouldhavebeenpaidonmycompensationafterJanuary1,2011,plus8per

centannualinterest;and

 Anyadministrativeexpensesincurredby

theERSinrespondingtomyemploymentbytheRCUHinviolationofthe

requirementsforreemploymentofaretirant,totheextentthatIamdeterminedtobeatfaultbyERS.



RequirementsforEmploymentofaRetirant

Iconfirmthat:

 IamorwillbeemployedinapositionthatisexcludedfromERSmembership;and

 Iwillnotbeemployedinalaborshortageordifficult‐to‐fillposition;and

 IhavenotbeenemployedbytheStateoranycountyforatleast

6consecutivemonthsduringthetimeIhavebeenretired;

and

 Noagreement(verballyorinwriting)wasmade,priortomyretirement,thatIwouldbeemployedbytheRCUHoranyother

StateorcountyagencyafterIretired.



Bysigningbelow,IconfirmthatIunderstandtheRequirementsforEmploymentofaRetirantandthatIunderstandtheconsequences

tomeifIdonotmeettheRequirementsforEmploymentofaRetirant.



_________________________________________________

 _________________________________

RETIRANTSIGNATUREDATESIGNED



Warning:Anypersonwhoknowinglyfurnishesfalseinformationtogovernmentauthoritiesmaybeguiltyofamisdemeanor,

punishablebyupto1yearofimprisonmentand/ora$2,000fine.HawaiiRevisedStatues§710‐1063.





RCUHFormattedERS‐209

Act179/SLH2010(01012011)



PARTII(TOBECOMPLETEDANDSIGNEDBYTHERCUH)

ResearchCorporationoftheUniversityofHawaii

2530DoleStreet,SakamakiD100

Honolulu,Hawaii96822

Phone:956‐3100

Fax:956‐5022



EFFECTIVEDATEOFHIRE:

 TheRCUHdidnotenterintoanagreement(verballyorinwriting)withtheRetirant,priortotheRetirant’s

retirement,thattheRetirantwouldbereemployedbytheRCUH.

 TheRetirantwillbeemployedinanRCUHpositionexcludedfromERSmembership(pursuanttoHRS§304A‐3001).



___________________________________________ __________________________________ 

NelsonSakamotoDateSigned

DirectorofHumanResources,RCUH



RCUHtoreturnthecompletedformwithin7businessdaysfromtheeffectivedateofhireto:Employees’RetirementSystem,201

MerchantStreet,Suite1400,Honolulu,HI96813‐2980

.



Returnformto:NelsonSakamoto,DirectorofHumanResources(nsakamoto@rcuh.com)



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RCUHCertificationofComplianceCurrentRCUHEmployee EmploymentofERSRetirantwiththeRCUH RCUHHumanResourcesDepartment (808)95669657055 nsakamoto@rcuh.com Act179becamelawonJune28,2010whichamendedChapter88,HRSPensionandRetirementSystemsas88 9withaneffectivedate

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Fill Online, Printable, Fillable, Blank RCUHCertificationofComplianceCurrentRCUHEmployee EmploymentofERSRetirantwiththeRCUH RCUHHumanResourcesDepartment (808)9566965/7055 nsakamoto@rcuh.com Act179becamelawonJune28,2010whichamendedChapter88, Form

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Fillable RCUHCertificationofComplianceCurrentRCUHEmployee EmploymentofERSRetirantwiththeRCUH RCUHHumanResourcesDepartment (808)9566965/7055 nsakamoto@rcuh.com Act179becamelawonJune28,2010whichamendedChapter88,

Fill Online, Printable, Fillable, Blank RCUHCertificationofComplianceCurrentRCUHEmployee EmploymentofERSRetirantwiththeRCUH RCUHHumanResourcesDepartment (808)9566965/7055 nsakamoto@rcuh.com Act179becamelawonJune28,2010whichamendedChapter88, Form

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