Form Center

Contact Information

First Name*
Middle Initial
Last Name*
Current Address*
City*
State*
Zip*
How long have you been at this address?*
1. Months
2. Years
Email*
How many months? *
How many years?*
Are you currently enrolled in the Public Employees Retirement System (PERS)?
1. Yes
2. No
Do you possess a valid driver’s license?
1. Yes
2. No
Are you a U.S. Citizen?
1. Yes
2. No
If Naturalized, give date:
If Naturalized, give date:
Did you serve in the military?
1. Yes
2. No
If yes, give the branch of service, date of enlistment, date and type of discharge, rank/ranks attained and whether or not you saw active duty.*
Can you speak, read or write any language besides English?*
1. Yes
2. No
Please specify the language and to what degree.
Answering “yes” to any of the following questions will not necessarily preclude the application from consideration.
Have ever been convicted of a crime or a motor vehicle moving violation?
1. Yes
2. No
Please describe each arrest/offense conviction, the year and the court:
Continue

Grade School / Middle School - Dates Attended*
Grade School / Middle School - Dates Attended Start Date
—
Grade School / Middle School - Dates Attended End Date
Highest Grade Completed*
High School Name / Location
Dates Attended
Dates Attended Start Date
—
Dates Attended End Date
Did you graduate?
1. Yes
2. No
College Name / Location
Dates Attended
Dates Attended Start Date
—
Dates Attended End Date
Diploma / Degree Attained
Major
Minor
Special Training, apprenticeships, courses, etc.
List course, facility/location, and length of time.
Continue |Go Back