Fillable Vesting Credit Vesting Credit (Nebraska)

Fill Online, Printable, Fillable, Blank Vesting Credit Vesting Credit (Nebraska) Form

Use Fill to complete blank online NEBRASKA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Vesting Credit Vesting Credit (Nebraska)

On average this form takes 10 minutes to complete

The Vesting Credit Vesting Credit (Nebraska) form is 1 page long and contains:

  • 0 signatures
  • 12 check-boxes
  • 34 other fields

Country of origin: US
File type: PDF

BROWSE NEBRASKA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
NPERS2100
Rev. 04/2021
Page 1 of 2
BAR CODE
Last First Middle
Name
Date of Birth - -
Plan Type
(Check One)
Retirement Number
School
State
County
Patrol
Address City State Zip
Home Phone
Work Phone
Employer
Application For Vesting Credit/Prior Service Credit
SEE REVERSE SIDE FOR COMPLETE INSTRUCTIONS
School/State/County/Patrol
Currently Employed By:
/
/
FT
PT
DATE OF HIRE
LIST ALL NEBRASKA PUBLIC EMPLOYMENT
The following should be completed by you within 180 days of your date of hire.
BELOW SHOULD REFLECT DATES YOU PARTICIPATED IN ANOTHER NEBRASKA GOVERNMENTAL PENSION PLAN.
PLACE OF EMPLOYMENT
(CHECK ONE)
DATES OF PARTICIPATION
FROM
TO
Full Time Part Time
/
/
/
/
Full Time Part Time
/
/
/
/
Full Time Part Time
/
/
/
/
IDENTIFY CONTACT PERSON FOR PREVIOUS GOVERNMENT PLAN:
Name:
Phone:
Employer:
Fax:
Name:
Phone:
Employer:
Fax:
Name:
Phone:
Employer:
Fax:
I hereby certify and warrant that, to the best of my knowledge and belief, the foregoing is true and correct.
Signature
of Member:
Date:
/
/
NPERS2100
Rev. 04/2021
Page 2 of 2
BAR CODE
Instructions for Completing the Application for Vesting Credit
For State and County members, vesting means to qualify for the employer contributions made on
your behalf.
For School and Patrol members, vesting means to qualify for a lifetime monthly retirement benefit
(other eligibility requirements must also be met to receive a lifetime monthly retirement benefit).
All past retirement participation must be in Nebraska Governmental Plans. It is your responsibility to have
the form properly completed and filed.
Examples of Nebraska Governmental Entities
• Nebraska State Agencies
• Nebraska Public Schools
• Nebraska County Agencies
• University of Nebraska – Lincoln, Omaha, & Kearney
• University of Nebraska Medical Center (UNMC)
• Nebraska City Agencies
• Wayne State College
• Peru State College
• Behavioral Health Regions
TOP SECTION (on page 1)
• School/State/County/Patrol Currently Employed By is where you work now.
• Date of Hire is the date you commenced working in your new position. If you are with the State
Patrol, this would be your date of graduation from camp. Check FT/PT to indicate full or part time
position.
MIDDLE SECTION (on page 1)
• List your Nebraska Governmental Retirement Plan information and/or past participation with your
current employer here.
• Dates are the dates you were in the plan, not when you were employed.
Sign the form and forward it to NPERS immediately. Your Vesting Credit Application will be considered
filed on time if your completed application is received by NPERS within 180 days of your employment.
There are no exceptions.
If you need assistance, call NPERS at (402) 471-2053 or Toll-Free at 1 (800) 245-5712.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Vesting Credit Vesting Credit (Nebraska)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 6 May 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document