SOCIAL SECURITY NUMBER ADDRESS DEPARTMENT DATE OF BIRTH M F UNIVERSITY OF HAWAII CITY STATE ZIP HOME PHONE HI DIVISION/SCHOOL LEEWARD COMMUNITY COLLEGE POSITION TITLE / /
Organization
HAWAII PTS / UNIVERSITY OF HAWAII CITY STATE ZIP HOME PHONE HI DIVISION/SCHOOL LEEWARD COMMUNITY COLLEGE POSITION TITLE / Medicare / / /
STATE OF HAWAII PTS DEFERRED COMPENSATION RETIREMENT PLAN for Part-Time, Temporary, and Seasonal/Casual Employees of the State ENROLLMENT FORM Please type or print in ink. Complete ALL information. Failure to complete an