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It does not replace or update your CalPERS beneficiary or the person designated to receive warrants forms. This form should be completed and returned to your supervisor who will forward one copy for inclusion in your personnel folder. PLEASE TYPE OR PRINT EMPLOYEE NAME LAST FIRST HOME TELEPHONE NUMBER M. I. CELL PHONE NUMBER HOME ADDRESS NUMBER AND STREET CITY ZIP CODE OFFICE UNIT PERSON TO NOTIFY IN CASE OF ACIDENT OR ILLNESS ALTERNATE BIRTH DATE NAME RELATIONSHIP ADDRESS STATE IF YOU HAVE A...
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