Appointments Application

1. Name of Applicant:
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If more than one, separate by comma.

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* State:
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3. Positions Sought
Willing to Waive
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5.Provide your current residence address and county:
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6. Please provide your current business or professional address:
(Leave blank if currently not working.)

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Please Note: You have to be officially registered in your county as "American Independent" or as "Decline to State" in order to put it as your party affiliation.

Identify the party and county in which you are registered to vote:

INFORMATION FOR REPORTING PURPOSES

8. To assist the Governor's Office with its reporting obligations (Gov. Code, §12011.5, subdivision (n)), applicants are asked to provide their gender and voluntarily provide their race/ethnicity. Use the categories below to choose the one with which you most closely identify.

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9. Please provide your complete educational history starting with the most recent. - Dates can be approximate.
(Leave Blank if there is no history.)
From:
To:


Work History
10. Please provide your complete professional work history, starting with the most recent. Be sure to include any past gubernatorial appointments. Dates can be approximate.

Work History 1
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Name, current phone number and address of your supervisor:
From:
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To:
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11. Military Service:
Service Dates: To

12. Professional Licenses & Certificates:
(Licenses/Certificates, Date Issued, etc. Keep blank if none.)
Received on: Expires on:


13. Organizations and society memberships:
(List all current organizations and societies of which you are a member. Include dates. Keep Blank if none.)
From: To:



14. Many positions require the appointment of persons with special background, experience, etc. Please indicate below those categories for which you may qualify. Please mark only the category which specifically describes your current occupation, employment or status.








































34.Identify your State Senator and Assembly Member.
If you are unsure as to your Senator or Assembly Member please visit http://www.leginfo.ca.gov/yourleg.html.



36.
FOR FAIR BOARD APPOINTMENTS ONLY
Do you or any members of your immediate family:





37.
FOR INTERN APPLICANTS ONLY



Availability:
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Office of Interest?