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PSRS Members

Non-Federal Public Employment Request Form

You will receive a written response by mail at the address you provide below.

*First Name:
Middle Initial:
*Last Name:
*Member Number:
Tip: Look on your annual PSRS Member Statement to find your member number.
*Street Address:
*City, *State, *Zip
, -
*Telephone Number:
 Email Address:
   
*Name of Employer:
*Inside/Outside the State of  Missouri:
*Full or Part-Time:
 If Part-Time, how many  hours per week?
   
* Required Fields