PDFWAC 415-108-660
Plan I union employer verification form.
Unions must use the following form to verify compliance with the requirements of WAC 415-108-620.
I certify under the penalty of perjury under the laws of the state of Washington that the following is true and correct: | |||||
_____, verifies that on the date of | |||||
Name of Union | |||||
_____ the _____ | |||||
(Must be a Date in November or December) | Identify Level of Union Organization (i.e. lodge) (hereinafter referred to as "organization") | ||||
possessed the following membership characteristics: | |||||
A. | Total number of organization members | _____ | |||
B. | Total number of organization members who are employees of a public employee retirement system (PERS) employer other than this union | _____ | |||
C. | Percentage of organization members who are employees of a public employee retirement system employer other than this union (B ÷ A x 100) | _____ % | |||
D. | The percentage identified in "C" is equal to or greater than 40% | _____ yes | |||
_____ no | |||||
If the answer to "D" is yes, then the organization is eligible to participate in PERS with regard to PERS Plan I union employees employed in an eligible position during the succeeding calendar year. Such employees shall remain eligible for participation while employed with the organization regardless of whether the organization continues to meet the requirements of WAC 415-108-620 and 415-108-630. | |||||
If the answer to "D" is no then the level of union organization identified above is not eligible to participate in the public employees' retirement system with regard to union employees employed in an eligible position during the succeeding calendar years. | |||||
Signature of Local/Division President or Person Designated in Writing by President as Having Authority to Verify | |||||