Applications will be processed ONLY for classifications where an examination
is in progress and the published final filing date has not passed, or for vacant
positions where a department requests an application.
STATE OF CALIFORNIA — STATE PERSONNEL BOARD
STD. 678 (REV. 12/2006) Page 1
PRINT OR TYPE — PLEASE SEE INSTRUCTIONS ON BACK PAGE
FOR SPOT EXAMINATIONS, ENTER THE LOCATION WHERE YOU WISH TO WORK
APPLICANT'S NAME (Last)
MAILING ADDRESS (Number)
HOME TELEPHONE NUMBER
WORK TELEPHONE NUMBER
EXAMINATION(S) OR JOB TITLE(S) FOR WHICH YOU ARE APPLYING
SOCIAL SECURITY NUMBER
ANSWER THE FOLLOWING QUESTIONS: (Answer questions 8, 9, 10, and/or 11 only if the examination indicates they are required.)
Enter the county in which you would like to take the
examination if different from the county of your residence:
Do you need reasonable accommodation to take an interview or written test?
Do your religious beliefs prevent you from taking an examination on Saturday?
Are you now employed by the State of California? (If "YES", fill in the information below.)
Have you ever been fired, dismissed, terminated, or had an employment contract terminated from any position for
performance or for disciplinary reasons? (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dismissals or terminations have been overturned, withdrawn [unilaterally or as part of a settlement agreement] or revoked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".) Refer to the Instructions for futher information. If "Yes" to Question #5, give details in Item #12.
In addition to English, list any other languages you:
possess verbal fluency in
possess written fluency in
I certify I can type at a speed of
words per minute. (For typing applicants only.)
(Answer Questions 8, 9, 10, and/or 11 ONLY if the examination indicates they are required.)