State of California Application
Instructions
Read the following instructions carefully before completing this application. Please complete the application on a computer or
print in ink. All questions must be answered completely and accurately, except as noted. You may be disqualied for any false
or misleading statements or for omitting information. The information you furnish will be used to apply for a job, determine your
eligibility and/or may be the basis for arriving at your nal rating in an examination. During the course of an examination, you may
be requested to provide additional information regarding your qualications, your preference regarding work location, shifts, etc.
Social Security Number (SSN) – Providing this is voluntary
in accordance with the Privacy Act of 1974 (PL 93-579).
However, a SSN may be needed to process your application
when granting items such as Veterans’ Preference, Limited
Examination and Appointment Program (LEAP), Career
Credits, and/or conrming list eligibility.
Examination(s) or Job Title(s) – Provide the title of the
position listed on the announcement.
Question 2 – Must be answered by all applicants. You must
answer “Yes” if you have ever, because of poor performance
or misconduct, been red, dismissed, or terminated from a job,
or had an employment contract terminated. Applicants who
have been rejected during a probationary period, or whose
dismissals or terminations have been overturned, withdrawn
(unilaterally or as part of a settlement agreement) or revoked
need not answer “Yes.” Explain any “Yes” answers in the
Explanations section. Briey describe the facts, ndings, any
action taken against you, and the circumstances under which
you left the position.
In completing this application, you do not need to answer “Yes”
to Question 2 if:
you have been rejected during a probationary period;
your employer withdrew the ring, dismissal, termination,
or contract termination (either voluntarily or as part of a
settlement); or
a court or administrative agency overturned or revoked the
ring, dismissal, termination, or contract termination.
If asked about past employment history by a prospective
employer during the hiring process or probationary period,
applicants are required to tell the truth regarding any ring,
dismissal, termination, contract termination or rejection during
probationary period, whether or not the action was overturned,
revoked, or withdrawn (either voluntarily by the employer or, as
part of a settlement agreement). Applicants are also required
to provide factually correct information in the Employment
History section of the application.
Question 3 – Must be answered by all applicants. Government
Code section 18720.45 requires applicants for state
employment to disclose on their application form whether they
have entered into any agreement(s) with the state in which
the applicant agreed to refrain from seeking or accepting any
subsequent employment with the state. You must answer
“Yes” to this question if you have ever entered into a written
agreement with any department, agency, commission, board,
state employer, or other governmental unit within California
state civil service, where one of the terms of the agreement
provided that you agreed not to seek or accept subsequent
employment with the state or any state agency. A state agency
includes any department, agency, commission, board, state
employer, or other governmental unit within the California
state civil service, but does not include the California State
University.
Question 4 – Must be answered by all applicants.
Government Code section 18720.45 requires applicants for
state employment to disclose on their application form whether
they have entered into any agreement(s) with the state in
which the applicant agreed to refrain from seeking or accepting
any subsequent employment with the state. You must answer
“yes” to this question if you have ever entered into a written
agreement with any department, agency, commission, board,
state employer, or other governmental unit within the California
state civil service, involving an adverse action, rejection on
probation, or AWOL termination where one of the terms of the
agreement provided that you agreed not to seek or accept
subsequent employment with a particular state agency. A
state agency includes any department, agency, commission,
board, state employer, or other governmental unit within the
California state civil service, but does not include the California
State University. If you answer “Yes” to this question, please
provide the name of the particular agency and the details in the
Explanations section.
Question 10 – If you checked “Yes” and you are not able to
attach the Accommodation Request form, you will be contacted
via telephone or mail to make specic arrangements.
Explanations – Use this section to explain the details of any
response that requires additional information. Be thorough,
and attach additional sheet(s) if needed.
Applicant’s Signature – Your signature and the date signed
is required. If the hard copy application is not signed, it may
be rejected. Electronic submission of your application through
a CalCareer Account certies your application in place of a
signature and date signed.
Education – You must include a complete record of your
training and educational background. Please read the
requirements of the examination bulletin for any specic
educational requirements. If more space is needed, you may
attach additional documentation.
STATE OF CALIFORNIA - CALIFORNIA DEPARTMENT OF HUMAN RESOURCES
EXAMINATION / EMPLOYMENT APPLICATION
STD. 678 (REV. 06/2024) Page 1