Fillable CALIFORNIA STATE SENATE (California)

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CALIFORNIA STATE SENATE (California)

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CALIFORNIA STATE SENATE
EMPLOYMENT APPLICATION
( )
Area Code Cell Phone
( )
Area Code Alternate Phone
Personal Email
Last Name First Name Middle Initial
Address
City State Zip Code
EMPLOYMENT DATA
Position Desired:
Full-Time Part-Time
Salary Desired: Date Available to Begin Work:
Have you ever worked for the State Legislature?
Yes No
House:
Have you ever worked for the State of California? Yes No
Department:
May we contact your current employer?
Name of Current Employer:
Yes
☐
No
☐
Referred to Senate Rules Committee by:
If you are related* to a current Senate employee, please list their name and relationship:
*For purposes of this section, “relative” is defined as a spouse, ex-spouse, child, parent, sibling, grandparent, grandchild, aunt, uncle, cousin,
niece, nephew, or corresponding in-law, “step” relation, domestic partner, or anyone related by marriage who is residing in the same household.
Are you currently receiving income benefits or have you made an application to retire from the California
Public Employees’ Retirement System (CalPERS)? Yes ☐ No ☐
EDUCATION
List school name and location, beginning with high
Years Did you
Major Degree
school:
Completed Graduate?
SKILLS
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:
EMPLOYMENT RECORD (INFORMATION REQUIRED - DO NOT REFERENCE RESUME)
(Start with current or most recent employer and include military service, if any. Please complete fully and do not refer to
resume. Attach additional sheets if necessary)
Company Name:
Title:
Addres
Job
s: Duties:
City: State:
From (mm/yy):
or:
To (mm/yy):
Supervis
Phone:
Hours per week:
Reason for leaving:
Company Name:
Title:
Address:
Job
Duties:
City: State:
From (mm/yy): To (mm/yy):
Supervisor:
Phone:
Hours per week:
Reason for leaving:
Company Name:
ob Title:
Address
J
:
Duties:
City: State:
From (mm/yy):
sor:
To (mm/yy):
Supervi
Phone:
Hours per week:
Reason for leaving:
Certification: I declare under the penalty of perjury, that this statement has been completed by me and
to the best of my knowledge and belief, is a true, correct, and complete statement in answer to the
questions contained herein.
SIGNATURE: ___________________________________________________________ DATE: __________________________
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CALIFORNIA STATE SENATE (California)

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Completed 23 February 2022

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