PERS Enrollment
You are required to complete this form. For more information, click here, handbook pages 37-38.
Member information
- Complete all sections.
- Current Name (first, middle initial (or) middle name) must appear exactly the way it appears on your current Social Security card.
Family information
- Complete all sections.
- Dependent cildren should be listed as long as they are not married; under age 19; between ages19-3 and are a full-time student at an accredited high school, college or university; or physically or mentally incompetent as judged by either a Mississippi court, or by the PERS board.
Previous membership information
- Answer the first two (2) questions.
- If you’ve never worked for a Mississippi State Agency, proceed to the section Member Certification.
- If you have worked for a Mississippi state agency, answer every question (Date of First Membership, Name of Previous Employer, Date First Membership Terminated and Dates of Refund, if applicable).
Member certificate