ࡱ> `b]^_'` bjbjLULU Z.?.?(DDDD4zVVVV"lN$ -4/ضڶڶڶK%M$hZq@-qDD3RTTTDRضTضTT:H,"Ш P)V&(t < h0~RFNFШШFXKMT}KKKqqDKKKN$N$N$<`d&N$N$N$`T@6vDDDDDD Instructions Retirement Application Forms The Application for Retirement (Page two) and Personal Data Sheet for Retirees (Pages three to five)) are used to apply for retirement from active service. If you need information on your eligibility to retire, please contact the Retirement Office.  Steps for completing the Application for Retirement form (page two of this file): The Application for Retirement should be completed and printed on Department letterhead. Applications should be submitted at least 60 days prior to your desired retirement date to your division, as applicable. If you are under age 60 on the date of your chosen retirement, you MUST apply directly through your division. Your application must first be approved by your division. You cannot apply directly with the Retirement Office. If you are age 60 or older on the date you have chosen for your retirement, you may apply either through your division or bring the form directly to the Retirement Office, Room 357, of the John Ferraro Building. Note: It is your responsibility to apply properly and as early as feasible to ensure you are approved in time to retire on your desired date. Note: You should refer to the Summary Plan Description or the How to Calculate Your Retirement Allowance booklets to determine your eligibility for retirement and learn more about the retirement process. Both are available at:  HYPERLINK "http://retirement.ladwp.com/publications.htm" http://retirement.ladwp.com/publications.htm Note: The Retirement Office offers Retirement Planning Seminars to Department employees who are currently eligible to retire or within three years of retirement eligibility. You may enroll by contacting your Division Training Coordinator.  Steps for completing the Personal Data Sheet for Retirees form (pages three to five): The Personal Data Sheet for Retirees is a separate form used to gather personal and confidential information for your retirement. It is not used to change or update your beneficiary information. The Personal Data Sheet for Retirees must be submitted directly to the Retirement Office. Your Personal Data Sheet for Retirees contains confidential information and should NOT be provided to your division. Please deliver your Personal Data Sheet for Retirees to Room 357 of the John Ferraro Building (7:30 am thru 4:30 pm). If you have any questions, please call (213) 367-1715. Thank you. (Rev. 01/19/2011) The Honorable Board of Date:  FORMTEXT       Water and Power Commissioners Room 1555, John Ferraro Building Honorable Members: APPLICATION FOR RETIREMENT I am applying for retirement to be effective on  FORMTEXT      . This application is made pursuant to the provisions of the Retirement Plan and Section 1184 of the Los Angeles City Charter. I will be  FORMTEXT       years of age and currently work in the  FORMTEXT       Division. I understand that this application must be filed with the Board of Administration of the Water and Power Employees Retirement Plan at least thirty (30) calendar days prior to the retirement date I have specified above. I also understand that I will only be retired if I meet all eligibility requirements. I also understand that should I choose to withdraw my retirement request, I must do so by written, signed, notification, which must be received by the Retirement Office no later than seven calendar days prior to my requested retirement date. I also agree to submit on the same day as this application, directly to the Retirement Office, a Personal Data Sheet for Retirees. I recognize I can send my Personal Data Sheet for Retirees via e-mail to  HYPERLINK "mailto:retire@ladwp.com" retire@ladwp.com, or deliver it to Room 357 of the John Ferraro Building. I understand my Personal Data Sheet for Retirees is needed to ensure my retirement paperwork is accurate, and, if I fail to provide this information as requested, processing of my retirement benefits will be delayed. (If you are applying for a Normal Retirement (age 60 or older), you may apply directly with the Retirement Office, Room 357 of the John Ferraro Building.) Sincerely, ___________________________________________ ______________ (Employee Signature Sign Here) (Date) Name: FORMTEXT      Employee No.: FORMTEXT      Payroll No.- Section No.: FORMTEXT    -  FORMTEXT   Department Phone(s): FORMTEXT       Recommended:Approved:Ronald O. Nichols FORMTEXT (Name of Division Head)General Manager FORMTEXT (Title of Division Head) Personal Data Sheet for Retirees PLEASE TURN THIS SHEET INTO THE RETIREMENT OFFICE (JFB - ROOM 357) DO NOT SUBMIT THIS SHEET TO YOUR DIVISION TARGETED EFFECTIVE RETIREMENT DATE: FORMTEXT       Member  Job InformationName: FORMTEXT      Employee No.: FORMTEXT       Civil Service Title: FORMTEXT       Division: FORMTEXT       Payroll No.: FORMTEXT       Department Phone: FORMTEXT      Member  Personal Information Social Security Number: FORMTEXT       Birth Date: FORMTEXT       Home Address: FORMTEXT       (cont)  FORMTEXT       City, State Zip Code: FORMTEXT      ,  FORMTEXT     FORMTEXT       Home Phone: FORMTEXT       Mobile Phone: FORMTEXT       E-Mail Address: FORMTEXT       Member s Service Information Prior Department/City/Government Service (check one)?  FORMCHECKBOX  No  FORMCHECKBOX  Yes If  Yes , did you already purchase the time (check one):  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  I m paying via contract(s). Describe any questions you have on prior service purchases:  FORMTEXT       Leaves from service: Type:  FORMCHECKBOX  Unpaid Leave  FORMCHECKBOX  Workers Comp  FORMCHECKBOX  N/A Describe any unpaid leave history you may have (Department or City):  FORMTEXT       Member s Divorce History Have you ever been divorced or legally separated?  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  In-progress. 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FORMTEXT      Address FORMTEXT      Phone FORMTEXT       FORMTEXT      City, State, ZIP FORMTEXT      Date of Birth FORMTEXT      Relationship FORMTEXT       Member s Living-Parent Information Father s Name FORMTEXT      Social Security No. FORMTEXT      Address FORMTEXT      Phone No. FORMTEXT       FORMTEXT      City, State, ZIP FORMTEXT      Date of Birth FORMTEXT      Mother s Name FORMTEXT      Social Security No. FORMTEXT      Address FORMTEXT      Phone No. FORMTEXT       FORMTEXT      City, State, ZIP FORMTEXT      Date of Birth FORMTEXT       ___________________________________________ (Employee Signature & Date) Thank you for promptly completing and returning this information. This information is necessary to help you with completing a smooth retirement process. This information will be used to ensure your retirement information and paperwork is accurate. Please note delays in providing this information will delay the processing of your retirement. PLEASE TURN THIS SHEET INTO THE RETIREMENT OFFICE (JFB - ROOM 357) PLEASE DO NOT SUBMIT THIS SHEET TO YOUR DIVISION If you have any questions, please call (213) 367-1715. 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