Prior State Service Form

Questions marked with a * are required

If you are a current employee and have previously worked for a Texas State agency, employment must be verified for appropriate service records. To report any previous employment for the purpose of Texas state service credit, the Office of Human Resources requests your assistance in completing the following form.

Employee Name:

First Name

Last Name

Maiden Name / Other:

Last 4 Digits of Social Security Number:

Email Address:

Name of Texas State Agency:

Start Date:

End Date:

Have you ever participated or currently contributing to the Teacher Retirement System of Texas (TRS), Optional Retirement Program of Texas (ORP) or Employee Retirement System of Texas (ERS)?

Yes