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:
Maiden Name / Other:
Last 4 Digits of Social Security Number:
Email Address:
Name of Texas State Agency:
Start Date:
End Date:
Do you have other state service to report?