Calpers Reciprocal Self-Certification Form - (last) (first) (middle) date of birth: Complete the following information and return this form to your personnel office within 10 business days. _____ i have not been a member of a qualifying public retirement system in california. Complete the following information and return this form to your personnel office. You must obtain the form from the member, completed, and kept for your records. Find out the requirements, benefits, and steps to submit a request online through mycalpers account. Web learn how to apply for reciprocity when you move from one california public retirement system to another without losing your benefits.
(last) (first) (middle) date of birth: Find out the requirements, benefits, and steps to submit a request online through mycalpers account. Web learn how to apply for reciprocity when you move from one california public retirement system to another without losing your benefits. Complete the following information and return this form to your personnel office within 10 business days. Complete the following information and return this form to your personnel office. _____ i have not been a member of a qualifying public retirement system in california. You must obtain the form from the member, completed, and kept for your records.