Appointments Application


Applicant Info
 
Date of Birth
 

Position Sought
   


Spouse Information
 

Current Residence Address and County

Current Business or Professional Address
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Voter Registration
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
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.

Please provide your complete educational history starting with the most recent. - Dates can be approximate.

 
From: 
  - To:  


Professional Work History
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
 
Name, current phone number and address of your supervisor
 
From: 
  - To:  
 


Military Service

 
Service Dates: 
  - To:  


Professional Licenses and Certificates

 
Received on: 
  - Expires on:  
 


Organizations and society memberships

 
From: 
  - To:  
 


Background and Experience
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.





















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Identify your State Senator and Assembly Member.
If you are unsure as to your Senator or Assembly Member please visit http://findyourrep.legislature.ca.gov

 

For Fair Board Appointments Only
Do you or any members of your immediate family

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