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Employee is paid by Calendar Year Jan-Dec by Fiscal Year July-June by School Year Sept-Aug by School Year Aug-July Yes No If Yes check ONE of the boxes in a - i explaining on what basis the Is employee electing not to enroll at this time employee declined membership or is electing not to enroll See Section 1 on reverse for eligibility guidelines. Certifying Official Signature Arlene Rochefort Print/Typed Name Preview Submit Date 207 799-2217 Phone arochefort capeelizabethschools. The records...
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