Fillable retired annuitant self certification form

Information on this form will be used by State agencies for the purposed of identification and document processing. It is mandatory to furnish all information requested on this form. DPA 715 NEW 02/05. RETIRED ANNUITANT SELF CERTIFICATION FORM To be completed by each retired annuitant applying for employment or currently employed with State government. You will not be eligible to return to work as a retired...
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retired annuitant self certification form
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