Fillable TEMPORARY EMPLOYMENT REPORT Tennessee Consolidated Retirement System (State of Tennessee)

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TEMPORARY EMPLOYMENT REPORT Tennessee Consolidated Retirement System (State of Tennessee)

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TR-0228 (Rev. 6/12) RDA-413
Page 1 of 3
TEMPORARY
EMPLOYMENT
REPORT
Tennessee Consolidated Retirement System
502 Deaderick Street
Nashville, Tennessee 37243-0201
1-800-770-8277 http://tcrs.tn.gov
The retiree and proposed employer must complete and sign this form and return it to the Tennessee
Consolidated Retirement System (TCRS) at the above address before the employment begins. It is the
retiree’s and the employer’s responsibility to notify TCRS should employment exceed the allotted time
period. Please read the following carefully, complete Sections 1 through 3 and, if applicable, complete
the certifi cation in Section 4 or Section 5.
SECTION 1. CONDITIONS OF TEMPORARY EMPLOYMENT (to be completed by employer)
T.C.A., Section 8-36-805 permits a retired TCRS member to accept temporary employment with an employer
participating in TCRS without suspension of retirement benefi ts provided the retired member has been retired 60
days and does not accrue additional retirement credit as a result of such employment.
a. The 60-day period may be waived provided the member renders no more than one-half of the hours he/she
was normally scheduled to work prior to retirement for a like period and the head of the employing entity
certifies in writing (Section 4) to the division of retirement that no other qualified persons are available to fill
the position. Once retired for more than 60 days, the remaining time may be allocated at full-time or used
over the one year period.
b. Compensation cannot exceed 60% of the retiree’s fi nal year’s salary plus 5% compounded annually since
retirement.
c. Disability retirees are subject to a disability earnings limitation in addition to these limits on the number of
days worked and salary. Please contact the TCRS disability section for details.
Please check one of the following:
(1) The retired employee accepts employment as a teacher by an institution of higher learning for up to 24
quarter credit hours or 18 semester credit hours during a 12-month period and the total salary payable to
such retired member during the period does not exceed the prorata share of average salary being paid
at the institution in the specifi c academic discipline concerned.
(2) The retired employee accepts employment as an adult education teacher by an institution for up to 120
days during a 12-month period and the total salary payable to such retired employee during the period
does not exceed the prorata share of average salary being paid at the institution in the specifi c academic
discipline concerned.
(3) The retired employee accepts employment with a covered employer for up to 120 days during a 12-month
period.
TR-0228 (Rev. 6/12) RDA-413
Page 2 of 3
(4) The retired employee has been employed as a substitute teacher in a public school system under
exception number 3 above and agrees to continue such substitute teaching for an additional 90 days
during the 12-month period. The compensation payable to the retired employee for such additional days
does not exceed the rate set by the school system for substitute teachers fi lling similar vacant positions.
The Superintendent of the Public School System must complete the certifi cation in Section 3.
(5) The higher education retired employee accepts an emeritus appointment not to exceed 120 days or
teaching service not to exceed 24 quarter hours or 18 semester hours during a 12-month period. See
Section 4.
SECTION 2. APPLICANT INFORMATION
Member ID Last 4 SSN XXX-XX- Date of Birth
Full Name
Mailing Address
City State Zip Code
Email Phone Number
I hereby certify that I have read this form and understand my rights and limitations upon accepting temporary
employment. Specifi cally, I am aware that should I accept such temporary employment, I will not be eligible
to accrue additional retirement credit as a result of such service. Further, I am aware that should I exceed
the applicable work and compensation limits set forth in Section 2 of this form, my retirement benefi ts will
be suspended and adjusted to recover any overpayment which may occur. I understand that the permitted
employment period commences from the date my temporary employment begins.
Applicant’s Signature Date
SALARY LIMIT FOLLOWING RETIREMENT
(Final Year’s Salary x 1.05 Per Year x 60%)
120-DAY CONVERSION TO HOURS
Year 1 63.00% 8 hours a day = 960 hours a year
Year 2 66.15% 7 1/2 hours a day = 900 hours a year
Year 3 69.46% 7 hours a day = 840 hours a year
Year 4 72.93%
Year 5 76.58%
Year 6 80.41%
This table sets out the maximum compensation levels for the fi rst six years. Since 120
days is 60% of a regular workload, these limits should be considered reasonable. The table
should not be interpreted as setting the pay scale for a retiree who has accepted temporary
employment. The actual pay can be lower than the limit.
TR-0228 (Rev. 6/12) RDA-413
Page 3 of 3
SECTION 3. TEMPORARY EMPLOYMENT INFORMATION (to be completed by employer)
The employer shall submit a statement of working hours for the retiree when requested and shall be subject to
audit to verify working hours. This form only covers the employment period stated in Section 3. Please submit
only one form for a 12-month period.
Beginning Date of Employment for 12-Month Period
Anticipated Termination Date
Number of Hours Worked Per Day Prior to Retirement
Number of Hours to be Worked Per Day after Retirement
Projected Maximum Compensation to be Paid During this Temporary Employment Period $
Employed By (Department, County, City or Institution)
Mailing Address
City State Zip Code
Email Phone Number
Agency Head or Designee’s Signature
Printed Name and Title Date
SECTION 4. CERTIFICATION BY SUPERINTENDENT / DEPARTMENT HEAD (to be completed
only if number 4 of Section 1 is checked or if the retiree is being permitted to work up to 50%
during the 60-day period immediately following his/her date of retirement)
I hereby certify that I am the superintendent/department head of the above-named public school system/
department and that no other qualifi ed personnel are available to substitute teach/work during the employment
period specifi ed in Section 1 above. I further certify that the compensation payable to the retired member for such
work will not exceed the rate of compensation set by the public school system/department for other employees
fi lling similar vacant positions.
Superintendent or Department Head’s Signature
Printed Name and Title Date
SECTION 5. EMERITUS CERTIFICATION (provided only if number 5 of Section 1 is checked)
Employer must attach information which refl ects duties performed, compensation and residence during the
contract term.
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TEMPORARY EMPLOYMENT REPORT Tennessee Consolidated Retirement System (State of Tennessee)

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Completed 27 January 2021

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