California State Senate Employment Application Form

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CALIFORNIA STATE SENATE
EMPLOYMENT APPLICATION
___________________________________________________________
_______-_______-_______
Last Name
First Name
Middle Initial
Social Security #
___________________________________________________________
(______)________________
Address
Area Code
Home Phone
___________________________________________________________
(______)________________
City
State
Zip Code
Area Code
Work Phone
EMPLOYMENT DATA
Position Desired:
Full-Time
Part-Time
Salary Desired:
Date Available to Begin Work:
Have you ever worked for the State Legislature before? Yes
No
House:
Have you ever worked for the State of California before? Yes
No
Department:
May we contact your current employer?
Name of Current Employer:
Yes
No
Referred to Senate Rules Committee by:
If related to a current Senate employee, please list name and relationship:
Are you currently receiving, or have you made application for, retirement benefits under the Public Employees’
Retirement System? Yes
No
EDUCATION
Major
Degree
Years
Did you
List school name and location, beginning with high school:
Completed
graduate?
Do you have any other experience, training, qualifications, or special skills, which you feel may make you
especially suited in performing the job for which you are applying? If so, please explain:
__________________________________________________________________________________________
__________________________________________________________________________________________
Have you ever been convicted of a felony? Yes
No

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