Temporary_Employee_Retiriee_Disclosure_Form.pdf

This is a Temporary Employee Retiree Disclosure Form required by the City of Tucson for temporary staffing placements under the Temporary Employment and Staffing Services contract opportunity. The form must be completed by all temporary employees prior to their first day of assignment, with contractor agencies responsible for collection and submission to the City. The disclosure requires employees to provide their full name, last four digits of Social Security Number, contractor agency name, and assigned position/department. Employees must disclose their retirement status, specifically indicating whether they are retirees of the Tucson Supplemental Retirement System (TSRS) or the Public Safety Personnel Retirement System (PSPRS), or confirming they are not retirees of either system.

The form requires employee signature and contractor representative signature with dates, followed by City of Tucson Human Resources Department approval with an authorized representative's name, signature, and date. The critical requirement states that if a temporary employee is a retiree of TSRS or PSPRS, their placement with the City cannot proceed without prior written approval from the Human Resources Department. Employees must affirm under penalty of potential immediate removal that all disclosed information is true and accurate. This disclosure requirement applies across all service categories offered under the City's staffing services solicitation, which includes General Staffing, Information Technology Staffing, and Finance and Business Services Staffing groups available to participating Axia Cooperative purchasing program agencies.