Post Retirement Employee Statement Form~1.doc
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- Attached to
- Training and Curriculum Development
- Solicitation number
- BD-18-1034-0998-0998-27854
- Issued by
- Worcester County, Massachusetts
About this file
This document is a Post Retirement Employment Statement of Earnings form from the Commonwealth of Massachusetts. It outlines the rules and requirements for retirees of the Commonwealth or any county, city, town, district, or authority to be employed for up to 960 hours per calendar year. The form requires the retiree to provide details on their prior position, retirement date, salary, and pension. It also requires the retiree to provide information on the new 960-hour position, including the job title, hourly rate, hours per week, and maximum annual earnings. The retiree must certify that they understand the 960-hour and earnings limitations and agree to return any excess earnings.
The document is related to a state and local contract opportunity in Massachusetts for Training and Curriculum Development services. The Commonwealth is seeking responses from individuals and organizations that can deliver training to professional adults working in a child welfare setting and develop curriculum in the field of child welfare as well as in areas that support child welfare. No additional details on pricing, funding, or the current environment are provided.
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Text version
THE COMMONWEALTH OF MASSACHUSETTS
POST RETIREMENT EMPLOYMENT
STATEMENT OF EARNINGS
A person who has been retired and who is receiving a pension, disability pension or retirement allowance from the commonwealth, or from any county, city, town, district or authority may be employed in the service of the Commonwealth for up to 960 hours in the aggregate in any calendar year. Such person shall serve at the will of the Appointing Authority.
I am / am not (circle) receiving a pension or retirement allowance from the Commonwealth of Massachusetts; or from any county, city, town, district or authority.
Retirement Information:
Retired From: ____________________________
Position Held: _____________________________
Retirement Date: ___________________ Salary: _________________
Pension: _____________________
960-Hour Position Information:
Position Applied: _______________________________________
Hourly Rate: _____________ Hours Per Week: ______________
Maximum Annual Earnings: ____________ (attach explanation of computation)
Weekly Schedule: ________________________________________
I understand that I am required to certify to my employer the number of days or hours that I have been employed in any calendar year and the amount of earnings during that calendar year. If the number of hours exceeds nine hundred and sixty, or if the earnings exceed the amount allowable under M.G. L. Chapter 32 Sec. 91 (b), I am required to return to the appropriate treasurer or other person responsible for the payment of compensation all such earnings as are in excess of said allowable amount.
Print Employee Name
Signature of Employee/Date
Supervisor Approval/Date
HR Approval/Date
2/28/2014
File details come from the government source that posted it. Updated .