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| Other names previously used for school or employment: |
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| State (enter NA if a non US address): |
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| Are you 18 years of age or older?: |
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| Are you either a US citizen or can you provide evidence of your legal right to work in the US?: |
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| Have you ever been employed by the University, a DOE Laboratory, or the State of California?: |
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| If yes, indicate dates of employment: |
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| Are you a current UC employee?: |
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| If yes, please enter campus/lab name: |
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UC requires the following information from UC retirees, including those who took a Lump Sum Cashout as well as those who receives a Monthly Retirement Income, for compliance with UC hiring policy.
Have you retired from UC?: |
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| Are you currently receiving a UCRP monthly pension?: |
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| Did you receive a Lump Sum Cashout at the time of your retirement? |
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| Do you have any relatives currently employed in University of California Office of the President?: |
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| If yes, indicate names, relationship, and departments: |
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| May we share your resume with other UC departments andor UC locations?: |
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| Would you be interested in temporary assignments in the Temporary Office of the President Staffing TOPS program?: |
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