In the vast ecosystem of employment benefits and retirement planning within the state of California, the ES 0350 form plays a pivotal role for certain education sector employees. This document, officially titled "Permissive Election and Acknowledgement of Receipt of CalSTRS Defined Benefit Plan Membership Information," serves as a bridge for those individuals not automatically enrolled in the California State Teachers’ Retirement System (CalSTRS) due to specific exclusions. It opens up the opportunity for eligible employees who perform creditable service—as defined in Education Code Section 22119.5—but are exempt from mandatory membership, to voluntarily choose to participate in the CalSTRS Defined Benefit Program. This choice, once made, is irrevocable as long as the individual remains employed in a position that involves creditable service. The process is detailed and requires careful attention, not only from the employee making this significant financial and career-related decision but also from the employing entity, which must validate the employee’s choice and ensure all criteria and timelines are met. The form lays down a clear framework for this election, emphasizing the irreversible nature of the decision and underscoring the legal responsibilities and potential consequences for misrepresentation. With areas for both employee certification and employer confirmation, it encapsulates a moment of agreement and compliance with California's educational retirement system regulations.
| Question | Answer |
|---|---|
| Form Name | Form Es 0350 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | false, submits, pursuant, applicable |
PermissiveMembership
ES 0350 (Rev. 6/11)
PERMISSIVE ELECTION AND ACKNOWLEDGEMENT OF RECEIPT OF CALSTRS DEFINED BENEFIT PLAN MEMBERSHIP INFORMATION
California State Teachers’ Retirement System
P.O. Box 15275, MS 17
Sacramento, CA
CalSTRS.com
An employee who performs creditable service (Education Code Section 22119.5), and who is excluded from mandatory membership pursuant to Section 22601.5, 22602, or 22604, may elect membership in the California State Teachers’ Retirement System (CalSTRS) Defined Benefit Program at any time while employed to perform creditable service. If you elect membership below, then your election becomes irrevocable until you terminate employment. This form containing your election must be on file with CalSTRS before your employer submits contributions into the program.
EMPLOYEE CERTIFICATION
NAME (LAST, FIRST, INITIAL) |
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CLIENT ID OR SOCIAL SECURITY NUMBER |
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MAILING ADDRESS |
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POSITION TITLE |
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CITY |
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With my signature below, I certify that I have received information from my employer on my eligibility to elect membership in CalSTRS Defined Benefit Program and that I am making the following election. I fully understand this election is irrevocable and applies to all future creditable service until I terminate employment.
I understand it is a crime to fail to disclose a material fact or to make any knowingly false material statements for the purpose of altering a benefit administered by CalSTRS and it may result in penalties, including restitution, up to one year in jail and a fine of up to $5,000 (Education Code Section 22010).
I elect membership |
I decline membership at this time |
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SIGNATURE |
DATE |
TO BE COMPLETED BY EMPLOYER
With my signature below, I certify that the
OFFICIAL’S SIGNATURE |
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COUNTY (or Other Employing Agency) |
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EMPLOYEE #
SEX
MALE FEMALE
BIRTHDAY
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MEMBERSHIP DATE
(MO/DAY/YEAR)
ASSIGNMENT
FT PT SUB
PERMISSIVE MEMBERSHIP • REV 06/11