Article Please complete and submit this form and we will be in touch with you soon. Note: Fields with a asterisk are required. First Name Last Name Email address Phone Number Date of Birth Are you retired - either receiving a monthly Service Retirement or Disability benefit from ERSRI, or have a retirement benefit that is awaiting processing? Yes No If yes, please provide your retirement date. Please provide the following information about the Agency/Employer and position from which you retired. Former Agency/Employer Name Former Position Please provide the following information about the position you are interested in working as a retiree: Prospective Start Date (or Actual Start Date, if already accepted or begun) Post-Retirement Agency/Employer Post-Retirement Position Brief description of job duties. Enter your question(s) in the space below. Provide as much detail as possible.