Revised January 2014

PRE-EMPLOYMENT PHYSICAL INSTRUCTIONS

As part of your conditional offer of employment, you have been scheduled for a pre-employment physical at the Occupational Health Clinic, 230 North Woodland Boulevard, Suite 250, Deland, Florida. This office is located at the corner of Woodland Boulevard and Wisconsin Avenue in the Bank of America Building on the second floor.

This packet includes the following eight forms that must be filled out prior to your appointment:

1. Drug, Alcohol, and Nicotine Test Acknowledgement Form 2. Medical History Questionnaire 3. Pre-Employment Physical Authorization and Consent Form 4. Respiratory History and Spirometry Questionnaire 5. Social Security Number Collection Disclosure 6. A. Release of Information – 49 CFR Part 40 Drug and Alcohol Testing

B. Applicant Statement Regarding Department of Transportation (DOT) Pre-employment Drug or Alcohol Tests (Complete forms only if candidate is required to have a Commercial Drivers License (CDL) for position or subject to Federal Aviation Administration (FAA) drug/alcohol testing)

7. Employment-Related Drug Information and Consent for Drug Usage Urinalysis and Physical (Complete only if candidate is a minor)

8. Florida Retirement System (FRS) Certification Form

Selected candidates must:

Plan to arrive at least 15 minutes prior to scheduled appointment time;

Bring a list of all medications you’re currently taking; and,

Bring your state-issued driver’s license or other state-issued identification card; and

Original social security card or a recent receipt from the Social Security Office (with your name and social security number on it). Call 1-800-772-1213 for the nearest Social Security Office location if you need to obtain a new card.

If FASTING IS REQUIRED: Please have nothing to eat for 8-12 hours prior to your physical. You may have water or black coffee and any medications that you are required to take.

LATE ARRIVALS: In consideration of others, if you arrive 15 minutes or later after your scheduled appointment time, you may be rescheduled for another time and/or day if we’re unable to work you in among the other scheduled appointments. Rescheduling an appointment may delay your start date with the County.

NOTIFICATIONS: You and/or your Department/Division, depending on the type of physical required of the position, will be notified of results within approximately three to five business days unless you’re placed on a medical hold.

If you have any questions or need assistance downloading and/or completing these forms, please contact the Occupational Health Clinic section at (386) 736-5984.

Revised January 2014

(1) DRUG, ALCOHOL, AND/OR NICOTINE TEST ACKNOWLEDGEMENT FORM

Special Risk and/or Safety Sensitive Positions

I understand that testing for the presence of chemical substances or metabolites (legal and illegal drugs), alcohol and/or nicotine is being conducted in accordance with federal and state laws and County policies.

Job Applicants: I understand that as a job applicant with the County of Volusia, that my refusal to submit to the above testing, or a confirmed positive test result, is considered cause for refusal to hire me.

Current Employees/Volunteers: I understand that my refusal to submit to drug, alcohol and/or nicotine testing, or a confirmed positive test, may be considered a violation of federal regulations and/or County policies and will result in disciplinary action up to and including termination of employment or severance of my volunteer duties. Additionally, a confirmed positive drug or alcohol test may result in forfeiture of workers’ compensation benefits and have other criminal, legal, and employment consequences.

Special Risk Positions I understand that if I am in a Special Risk Position (see page 2), it is a condition of my employment that I cannot consume nicotine at any time (on or off duty) during my employment at the County of Volusia. I also understand that if I have a confirmed positive nicotine test during my probationary period, I will be automatically terminated. If I have completed my probationary period and have a confirmed positive nicotine test at any time during my employment at the County of Volusia, I will be subject to disciplinary action up to and including termination.

I also understand that I may request the testing laboratory to send the original urine specimen to another certified laboratory for retesting for drugs within 72 hours of notification by the Medical Review Officer (MRO) and that the County may seek reimbursement for all or part of the cost of the split specimen retest. I further understand that if I receive a positive confirmed drug or alcohol test result, I may explain or contest the result to the County within five (5) working days after receiving written notification and I must inform the testing laboratory of any administrative or civil action brought pursuant to drug-free workplace testing procedures and have the right to consult the Medical Review Officer (MRO) for technical and confidential information regarding prescription and non-prescription medications.

I have read this form (or this form has been read to me at my request for a reasonable accommodation under the provisions of the American with Disabilities Act-ADA) and I fully understand its meaning and the consequences of a positive drug, alcohol, and/or nicotine test.

________________________________ ________________________________ ______________

Print Applicant/Employee Name Signature Date

Applicants or volunteers under age 18 require a parent or legal guardian’s signature.

________________________________ _______________________________ _______________

Print Parent/Legal Guardian Name Signature Date

Revised January 2014

Special Risk Positions

All special risk employees hired shall be non-tobacco users at the time of hire as a condition of employment and shall be required, as an absolute condition of employment to refrain from use of tobacco products of any kind, on or off duty, during employment with the County of Volusia. Beach Safety

Beach Deputy Chief Beach Director Beach Safety Specialist Lifeguard Supervisor Senior Lifeguard

Corrections Corrections Assistant Director Corrections Captain Corrections Director Corrections Lieutenant Corrections Officer Corrections Officer Trainee Corrections Sergeant Senior Corrections Officer Warden

Emergency Medical Services (EVAC)

Emergency Medical Technician Lieutenant Paramedic Paramedic Sergeant Paramedic

Fire Services Deputy Fire Chief Fire Division Officer Fire Captain Firefighter Fire Inspector Fire Lieutenant Fire Services Director Volunteer - Firefighter, Fire Police, Fire Support

Sheriff Captain Deputy I & II Flight Paramedic Internal Investigator Lieutenant Reserve Officer Sergeant Sheriff

Revised January 2014

Post-Offer Employment Physical Fitness-for-Duty Physical Annual Physical

(2) MEDICAL HISTORY QUESTIONNAIRE

Have you ever been examined medically by Volusia County? If so when?

Please Print Name Last First Middle Soc. Sec. No. Date of Birth Age Gender

Male Female

Home Address City & State Zip Code

Position Department Examination Date

NOTICE: The answers to these questions must be complete and true. Any false statement or omission of a material fact is sufficient cause for, and may result in consequences up to and including termination.

HISTORY: To be completed out by applicant/employee prior to day of examination and checked by nurse.

HAVE YOU EVER HAD, OR DO YOU NOW HAVE, ANY OF THE FOLLOWING DISEASES OR CONDITIONS?

Explain YES answers and sign your name in the Comment Section on page 3.

YES NO YES NO

1 Head injury or concussion 25 Heart infection

2 Are your teeth in good repair 26 Prolapsed heart valve

3 Cancer of any type 27 Coronary Artery Disease

4 Diabetes 28 Clogged arteries

5 Liver disease 29 High blood pressure

6 Skin disease 30 High cholesterol

7 Allergic reaction of any kind 31 High triglycerides

8 Rupture or hernia 32 Phlebitis

9 Epilepsy or convulsions 33 Varicose veins

10 Are you restricted from driving 34 Ear nose or throat issues (not related to colds or flu)

11 Eye injury or disease 35 Blood clots

12 Mouth or gum disease 36 Poor circulation

13 Kidney or urinary tract disease or failure? 37 Bleeding disorder or anemia

14 Mental or emotional illness or conditions Head

injury or concussion 38 Frequent nosebleeds

15 Have you ever contemplated suicide 39 Vomiting of blood

16 Ever had Hepatitis A, B, or C 40 Blood in urine

17 Ever diagnosed as obese 41 Blood in stool or black tarry stool

18 Have a regular exercise program 42 Stroke

19 Nervous breakdown 43 Ulcers

20 Disorder related to stress 44 Blood transfusion

21 Had abnormal lab results 45 Does your heart race or skip beats

22 Heart disease 46 Any other cardiovascular disease not mentioned in

this section

23 Rheumatic fever 47 Had an EKG, Stress test, Echocardiogram, Heart

Catheterization or other cardiovascular testing

24 Heart murmur 48 Ever refused treatment for cardiovascular problems

Page 1 (Please sign bottom of page 3.)

Revised January 2014

YES NO YES NO

49 Had a chest x-ray? 80 Coughing up phlegm, sputum or mucus

frequently

50 Had an abnormal chest x-ray? 81 Chronic cough without producing mucus, etc.

51 Wheezing or trouble breathing at times 82 Used oxygen at home or in the hospital

52 Pleurisy more than once before 83 Other respiratory disease

53 Bronchitis more than three (3) times in one

year 84

Ever refused medical treatment for any lung

disorder

54 Pneumonia, more than once in your life 85 Arthritis

55 Tuberculosis (TB) 86 Rheumatism

56 Exposure to someone with TB 87 Bursitis

57 Coughing up blood 88 Tendonitis

58 Torn cartilage, knee, ankle, shoulder 89 Have a history of substance abuse or alcohol

59 Epileptic Seizures 90 Are you addicted to any drugs or alcohol

60 Herniated or slipped disc 91 Have been treated for drug or alcohol

addiction

61 Fasciitis 92 Have you ever used tobacco products

62 Scoliosis or Lordosis 93 Do you still use tobacco products

63 Pain or loss of feeling in legs, feet, or ankles

94 Have you used tobacco products in the last 12

months?

64 Chronic back pain 95 Do you smoke?

65 Carpal Tunnel (Right/left/both) 96 Are you being treated for any current medical

condition (explain in comments)

66 Disease of the spine or vertebra 97 Have you ever experienced a serious illness

or injury (explain in comments)

67 Need to use cane, crutches, walker or other assistive devices

98 Ever been hospitalized? (explain in

comments)

68 Recurrent stiffness or back pain 99 Ever been injured on the job or experienced

any job related illnesses (explain)

69 Recurrent pulled muscles, tendons or

sprains 100

Have any mental or physical impairments originating from birth (flat feet, hearing loss, etc.)

70 Ever treated for musculoskeletal problems or injury

101

Women: Are you pregnant

71 Have or had a job requiring heavy lifting,

standing, walking, sitting for long periods of time

102 Take any prescription or non prescription

medications or supplements (list in comments)

72 Have or had any broken bones 103 Ever received radiation treatment

73 Have or ever had any other musculoskeletal disorder, or disease

104

Otherwise been exposed to radiation

74 Ever refused treatment for any

musculoskeletal injury, disorder or disease

105 Ever had any communicable diseases (such

as measles, mumps, chicken pox) Explain in comments.

75 Can you lift 1 to 10 pounds 106 Ever been in an accident that caused loss of

time from work (auto, boat, motorcycle, etc.)

76 Can you lift 10 to 20 pounds 107 Ever had a work related accident

77 Can you lift 25 to 50 pounds 108 Had the Hepatitis A vaccination (list dates)

78 Can you lift 50 to 100 pounds 109 Had the Hepatitis B vaccination (list dates)

79 Can you lift more than 100 pounds 110 Had a tetanus shot (list date of last)

Page 2 (Please sign bottom of page 3.)

Revised January 2014

COMMENT SECTION

(Reference corresponding question number next to each comment – use additional page if needed.)

I, the undersigned, do hereby certify that I have read and truthfully responded to each question on the

Medical History Questionnaire (Pages 1 through 3) to the best of my ability and knowledge. The answers I

have given to the questions are true and can be supported. I have no physical or mental impairments, except

as stated. I understand that any intentional omission, dishonesty in disclosure, or falsification of answers

written in this document may result in my termination of employment.

Print Name:____________________________Signature:__________________________Date:_________

Page 3

Revised January 2014

(3) PRE-EMPLOYMENT PHYSICAL AUTHORIZATION AND CONSENT FORM

I understand that I have been conditionally offered employment with the County of Volusia contingent upon passing a pre-employment physical. Any Protected Health Information gathered for this physical will remain under separate medical files in the Occupational Health Clinic. I also understand that if I do not pass the physical and/or do not sign this authorization, I cannot be employed by the County of Volusia.

The Undersigned agrees as follows:

1. I consent for the Volusia County Occupational Health Clinic medical personnel to provide me with a complete physical examination, including, but not limited to, all items required on the standard county physical form and if necessary a stress test, and tobacco usage test and therefore do hereby consent to said physical.

2. I authorize the release of the results stated as, “medically acceptable” or “medical unacceptable” only, as required to certify certain employees as employable.

3. I make the above agreements freely and voluntarily and with a full understanding of the physical examination.

4. By reading and initialing this, ________ (initials), I authorize clinic personnel to release my medical records concerning my job duties to my employer. This authorization is required in

order to meet Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations. I, the undersigned, do hereby certify that to the best of my knowledge, the answers I have provided to the questions herein are true and that I have no physical defects except as stated. I understand that any intentional omission or falsification of answers either verbally or in writing may result in termination of my employment.

___________________________ ____________________________ ____________

Print Applicant/Employee Name Signature Date

Applicants or volunteers under age 18 require a parent or legal guardian’s signature.

___________________________ ____________________________ ____________

Print Parent/Legal Guardian Name Signature Date

Revised January 2014

(4) RESPIRATORY HISTORY AND SPIROMETRY QUESTIONAIRE

Employee Name: _______ SSN:

Current Job or Position:

Have you ever had or currently have any of the fol1owing? (Check below if yes)

Asthma Food, Dust, or Animal Allergy Emphysema

Valley Fever Hay Fever, Sinusitis Collapsed Lung

Tuberculosis Chronic Bronchitis Abnormal Chest X-Ray

Other Lung Problem Surgery of Lungs, Heart, or Blood Vessels

YES NO

1

Have you ever worked with asbestos or in any dusty environment such as a

mine, stone quarry, foundry, farm, pottery, cotton, flax or hemp mill, or chemical

plants? (Underline if Yes) Other:

2 Have you ever worked with x-ray or any radioactive materials, or had any physical condition due to exposure to radioactive materials?

3 Have you ever had or currently have any hobbies that expose you to wood or other dust, gases, or fumes such as paints, glues and solvent? What?

4 Do you cough on most days? If Yes, is it in morning only? or all day?

5 Do you cough up Phlegm, Sputum, or mucous?

6 Have you ever noted wheezing, whistling or tightness in your chest?

7 Have you ever coughed up blood?

8 Do you get short of breath when hurrying on level ground, walking up a slight hill or

climbing stairs?

9 Are you using any medications for Lung or Heart Problems? What?

10 Have you ever smoked cigarettes? Average number per day ____ for ____ years. Last

smoked on _____. If stopped, when?

11 Any breathing difficulties when wearing a mask?

12 Any anxiety or claustrophobia when wearing a mask?

13 When working, do you need to wear eyeglasses? or contact lens?

14 Do you wear dentures?

15 Can you lift 35 pounds to shoulder level?

16 Have you had respiratory infection within the past three weeks, i.e. severe cold, pneumonia,

influenza, or bronchitis?

17 Have you smoked within the last hour?

18 Have you used an aerosolized bronchodilator in the past hour?

19 What kind of work have you done for the longest period? How many years?

Signature: _________________________________________ Date: ________________

Revised January 2014

(5) SOCIAL SECURITY NUMBER COLLECTION DISCLOSURE

FINANCIAL AND ADMINISTRATIVE SERVICES

PERSONNEL DIVISION

This statement is being provided to you pursuant to Section 119.071 (5), Florida Statutes. The Occupational Health Clinic collects your social security number and may disclose your social security number to a commercial entity for the following purposes, including but not limited to: drug testing administration, physical exams, medical records, blood work, worker’s compensation administration, claims investigation and for any purpose allowed under law not limited by protection under state or federal privacy laws. Social security numbers are also used as a unique numeric identifier and may be used for search purposes. The County of Volusia may disclose social security numbers to another agency or governmental entity if it is necessary for the receiving agency or governmental agency to perform its duties and responsibilities. I have read and understand the social security number disclosure statement: _____________________________________________________ Signature _____________________________________________________ Printed Name _______________ Date

Personnel Division

Occupational Health Clinic 230 N. Woodland Blvd. Suite 250 - DeLand, Florida 32720 Tel: 386-736-5984 – Fax: 386-740-5214 (www.volusia.org)

Revised January 2014

NOTE: Complete form only if position requires to have a Commercial Drivers License (CDL) or subject to FAA drug/alcohol testing.

(6A) RELEASE OF INFORMATION FORM - 49 CFR PART 40 DRUG AND ALCOHOL TESTING

** Complete a separate form for each DOT-regulated employer who has employed the employee during any period during the two years [five years if FAA safety-sensitive position] before the date of the employee's application or transfer. **

Employee Printed or Typed Name: SS/ ID Number:

Position Applied for: Dept./Div.:

I hereby authorize release of information from my Department of Transportation (DOT) regulated drug and alcohol testing records by my previous employer, listed in Section I-B, to the employer listed in Section I-A. This release is in accordance with DOT Regulation 49 CFR Part 40, Section 40.25. I understand that information to be released in Section II-A by my previous employer, is limited to the following DOT-regulated testing items:

1. Alcohol tests with a result of 0.04 or higher; 2. Verified positive drug tests; 3. Refusals to be tested; 4. Other violations of DOT agency drug and alcohol testing regulations; 5. Information obtained from previous employers of a drug and alcohol rule violation; 6. Documentation, if any, of completion of the return-to-duty process following a rule violation.

Employee Signature: __________________________________________________ Date: _______________________________

County of Volusia Personnel Division, Occupational Health Clinic, 230 N. Woodland Blvd., Suite 250, DeLand, FL 32720

Telephone: (386) 736-5984 Fax: (386) 740-5214

Designated Employer Representative: Barbara Brooke, LPN

Telephone: ( ) Fax: ( )

Designated Employer Representative (if known):

In the two years prior to the date of the employee’s signature (in Section I), for DOT-regulated testing:

1. Did the employee have alcohol tests with a result of 0.04 or higher? YES ____ NO ____

2. Did the employee have verified positive drug tests? YES ____ NO ____

3. Did the employee refuse to be tested? YES ____ NO ____

4. Did the employee have other violations of DOT agency drug and alcohol testing regulations? YES ____ NO ____

5. Did a previous employer report a drug and alcohol rule violation to you? YES ____ NO ____

6. If you answered “yes” to any of the above items, did the employee complete the return-to-duty process? N/A ____ YES ____ NO ____

NOTE: If you answered “yes” to item 5, you must provide the previous employer’s report. If you answered “yes” to item 6, you must also transmit the appropriate return-to-duty documentation (e.g., SAP report(s), follow-up testing record).

Name: ___________________________________________________ Title: ______________________________________________

Telephone #: ( ) Ext.: Date: ________________________

II-B. Name of person providing information in Section II-A:

A. IA. New Employer:

A. IB. Previous Employer

:

Section II. To be completed by the Previous Employer and transmitted by Mail or Fax to the New Employer listed in section IA:

II-A. Previous Employer

Revised January 2014

(6B) APPLICANT STATEMENT REGARDING DEPARTMENT OF TRANSPORTATION (DOT)

PRE-EMPLOYMENT DRUG OR ALCOHOL TESTS

This information is required by DOT Regulation 49 CFR Part 40.25.

Printed Name of Applicant: ________________________________________________________ Social Security Number: _____________________

Applicant: Read the statements below and check the one that applies (check only one statement)

[ ] I HAVE NOT taken any pre-employment drug or alcohol test administered by an employer to which I applied for safety-sensitive transportation work during the past two (2) years.

[ ] I HAVE NOT tested positive, or refused to test, on any pre-employment drug or alcohol test administered

by an employer to which I applied, but was not selected, for safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two (2) years.

[ ] I HAVE tested positive, or refused to test, on a pre-employment drug or alcohol test administered by an

employer to which I applied, but was not selected, for safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two (2) years. I have successfully completed the DOT return to duty process (including follow up testing) and will provide all required documentation to the employer.

[ ] I HAVE tested positive, or refused to test, on a pre-employment drug or alcohol test administered by an

employer to which I applied, but was not selected, for safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two (2) years. I HAVE NOT successfully completed the DOT return to duty process (including follow up testing).

Signature of Applicant: ______________________________________ Date: __________________

Revised January 2014

(7) EMPLOYMENT-RELATED DRUG INFORMATION AND CONSENT FORM FOR DRUG USAGE URINALYSIS AND PHYSICAL EXAM

(For Minors Only)

The Undersigned agrees as follows:

1. I consent for the Occupational Health Clinic to provide me with a complete physical examination including, but not limited, all items required, including a drug urinalysis, on the standard county physical form and do hereby consent to said physical.

2. I authorize the release of the results of said physical examination to Volusia County Government, State

Agencies required to certify certain employees, and to private physicians if needed for consultation.

3. I make the above agreement freely and voluntarily with a full understanding of the physical examination.

4. It is also understood that employment with the County of Volusia is dependent upon the successful completion of the physical examination.

5. I, the undersigned, do hereby certify that to the best of my knowledge the answers I have provided to the

questions herein are true and that I have no physical defects except as stated. I understand that any intentional omission of falsification of answers either verbally or in writing may result in termination of employment.

_________________________________________________ _______________________ Signed Date

As the parent or guardian of _______________________________________, the minor to be served by

Occupational Health Clinic, I request and consent to all of the above for and on behalf of said minor.

_______________________________________________ Parent/Guardian ________________________________________________ Relationship (e.g. Father, Mother, Guardian) ________________________________________________ Date

CERT Revised 02-2012 EMPLOYERS: RETAIN THIS FORM IN THE EMPLOYEE’S PERSONNEL FILE. DO NOT SEND THIS FORM TO THE FRS, UNLESS REQUESTED.

This form is not an offer of employment or an enrollment form. If hired, a Retirement Choice kit may be mailed to your home with an enrollment form. Florida Retirement System (FRS) - Certification Form

Name SSN Agency Name COUNTY OF VOLUSIA

Previous or Current FRS Employer

PLEASE COMPLETE SECTION I, II, III, OR IV

I. I have never been a member of a State of Florida administered retirement plan.

SIGNATURE DATE

II. I was or currently am a member of the following State of Florida administered retirement plan (also complete Section III or IV)1

FRS Pension Plan (incl. DROP) FRS Investment Plan State University System Optional Retirement Program (SUSORP)

State Community College Optional Retirement Program (SCCORP) Senior Management Service Optional Annuity Program (SMSOAP) Other

III. I am not retired from any State of Florida administered retirement plan. I understand that if it is later determined that I was a retiree and was reemployed during the first 6 calendar months after I retired or after my DROP termination date, or at any time during the 7

th through 12 months after I retired or after

my DROP termination date, I must repay all unauthorized benefits received (see Section IV for details),

or, if in the Investment Plan, terminate my employment. My employer may also be liable for repaying

any unauthorized benefits I received.

SIGNATURE DATE

Retiree Definition

You are considered retired if:

1. You have re-ceived any bene-fits under the FRS Pension Plan (including DROP), or

2. You have taken any distribution (including a roll-over) from the FRS Investment Plan, or alterna-tive retirement programs offered by state universi-ties (SUSORP), state community colleges (SCCORP), state government for senior managers (SMSOAP), or local govern-ments for senior managers.

IV. I am retired from a State of Florida administered retirement plan. My FRS Pension Plan retirement ef-fective date, DROP termination date, or date I received my first distribution from the FRS Investment Plan, SUSORP, SCCORP, SMSOAP, or other plan was ______________________.

If I am initially reemployed by an FRS-covered employer on or after July 1, 2010, I will not be per-

mitted to participate in a State of Florida administered retirement plan to earn an additional

retirement benefit.

I understand that as a Pension Plan retiree:

a. If I am employed by an FRS-covered employer in any type of position2 during the first 6 calendar

months after I retired or after my DROP termination date, my retirement and DROP status are

voided, all retirement and DROP benefits I received must be repaid,3

b. If I am reemployed by an FRS-covered employer at any time during the 7th

through the 12th

months after I retired or after my DROP termination date, my monthly retirement benefit must be

suspended

and I must reapply for retirement in order to receive future benefits.

4

and any unauthorized benefits received must be repaid.3 My employer may also be

liable for repaying any unauthorized benefits I received.

I understand that as an Investment Plan, SUSORP, SCCORP, or SMSOAP retiree:

a. If I am employed by an FRS-covered employer in any type of position2 during the first 6 calendar

months after I retired, I must repay3 any benefits received or terminate employment for an

additional period to satisfy the 6 calendar month termination requirement. b. If I am reemployed by an FRS-covered employer at any time during the 7

th through the 12

th months

after my retirement, I will not be eligible for additional distributions until I terminate employment or complete 12 calendar months of retirement.

4

SIGNATURE DATE

1If you are not retired and earned FRS service after certain periods in 2002 (depending on your employer), you must rejoin the FRS retirement plan you were enrolled in when you

terminated FRS-covered employment. You may have a one-time 2nd

Election to switch FRS retirement plans. Also, alternative retirement programs are available to certain employ-ees. Contact your employer for deadline and other information. 2Positions include OPS, temporary, seasonal, substitute teachers, part-time, full-time, regularly established, etc.

3Florida law requires a return of all unauthorized Pension Plan benefit payments or Investment Plan distributions received by a member who has violated the FRS termination or

reemployment provisions. Similar provisions apply to unauthorized SUSORP, SCCORP, or other state-administered plan distributions – contact that plan’s administrator for details. 4There are no reemployment exemptions/exceptions for Pension Plan members whose effective date of retirement or DROP termination date is on or after July 1, 2010 or Invest-

ment Plan, SUSORP, SCCORP, or SMSOAP members who retire on or after July 1, 2010.

STOP HERE