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The Personnel Record form is an essential document utilized by the California Department of Social Services to gather crucial information about employees in various facilities. This form requires individuals to provide their full name, contact details, and age, confirming whether they are over 18 years old. It also allows for the voluntary disclosure of a Social Security number for identification purposes, while seeking details of the last physical examination and tuberculosis test. Potential employees are asked about previous names, driving license status, and any history of license suspension. Additionally, the form collects job-related information, such as position title, salary, work hours, and their supervisor's name. Previous employment history is recorded, encouraging applicants to outline their experiences and reasons for leaving past jobs. Educational qualifications are significant here too, as applicants detail their highest completed education level, ongoing studies, and relevant coursework. References can be listed as well, ensuring additional context about a person's capabilities. Finally, the form verifies professional qualifications, including licenses, certificates, and memberships in organizations. Completing this form accurately is vital, as it sets the foundation for hiring and ensures compliance with regulations.

Personnel Record Example

STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY

PERSONNEL RECORD

(Form to be completed by employee)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

DATE

NAME OF FACILITY

FACILITY ADDRESS

FACILITY FILE NUMBER

1.PERSONAL

NAME (LAST

FIRST

MIDDLE)

TELEPHONE

 

 

 

 

 

 

 

(

)

 

 

ADDRESS

 

 

 

 

 

 

ARE YOU 18 YEARS OF AGE OR OLDER?

 

 

 

 

 

 

 

YES

NO

IF NO, PLEASE STATE YOUR AGE

 

 

 

 

 

 

 

 

 

_____________________________

 

 

 

 

 

 

 

SOCIAL SECURITY NUMBER: (VOLUNTARY FOR ID ONLY)

 

DATE OF LAST PHYSICAL EXAMINATION

 

DATE OF LAST TB TEST

-

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HAVE YOU EVER BEEN EMPLOYED UNDER A DIFFERENT NAME? YES NO

IF YES, PLEASE LIST ALL NAMES USED.

 

 

 

 

 

 

 

 

 

 

 

DO YOU POSSESS A VALID CALIFORNIA DRIVER'S LICENSE?

YES NO

 

 

HAS YOUR DRIVER'S LICENSE EVER BEEN SUSPENDED OR REVOKED? YES NO

CDL NUMBER

 

 

 

 

 

IF YES, PLEASE EXPLAIN ON BACK OF FORM.

 

 

 

NEAREST LIVING RELATIVE — NAME:

 

 

 

 

 

 

TELEPHONE NUMBER

 

 

RELATIONSHIP

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

2.POSITION

TITLE

SALARY

HOURS

DATE OF EMPLOYMENT

NAME OF SUPERVISOR

3.PREVIOUS EMPLOYMENT (List most recent experience first. If additional space is needed, please attach a separate page.)

NAME AND ADDRESS OF EMPLOYER

TELEPHONE

NUMBER

JOB TITLE AND TYPE OF WORK

REASON FOR

LEAVING

DATES

FROM TO

4.EDUCATION

CIRCLE HIGHEST YEAR COMPLETED

6

7

8

9

10

11

12

DIPLOMA

CURRENTLY ENROLLED IN HIGH SCHOOL COMPLETION COURSE?

NO

YES IF YES, GIVE EXPECTED COMPLETION DATE___________________

EMPLOYMENT — RELATED EDUCATION COURSES

COURSE TITLE

NAME OF SCHOOL OR ORGANIZATION

AND ADDRESS

NUMBERDATE CURRENTLY UNITS

COMPLETED COMPLETED ENROLLED

LIC 501 (3/99)

(OVER)

4.EDUCATION (CONTINUED)

NAME UNIVERSITY, COLLEGE OR BUSINESS SCHOOL

AND ADDRESS

MAJOR

SUBJECT

NO. OF

NO. OF

DIPLOMA

 

YEARS

UNITS

DEGREE OR

DATE

COMPLETED

COMPLETED

CERTIFICATE

COMPLETED

 

 

 

 

5. REFERENCES

List names of three persons who can give information about your background, character, abilities, etc.

NAME

ADDRESS

TELEPHONE

NUMBER

RELATIONSHIP TO YOU

(FRIEND, EMPLOYER, ETC.)

6.PROFESSIONAL AND TECHNICAL QUALIFICATIONS

A.List Licenses or Certificates of Competence held:

B.Names of Professional Associations of which you are a member:

NOTES:

I hereby certify under penalty of perjury that the above statements are true and correct. I give my permission for any necessary verification.

SIGNATURE OF EMPLOYEE

DATE

Form Characteristics

Fact Name Details
Purpose The Personnel Record form is designed to collect essential information from employees for administrative purposes.
Governing Law In California, the governing laws regarding personnel records can be found in the California Labor Code Section 1198.5.
Age Requirement Employees must indicate if they are 18 years of age or older, as this can impact employment eligibility.
Social Security Disclosure Disclosure of the social security number is voluntary and for identification purposes only.
Previous Employment Applicants are required to list their most recent employment experiences and provide reasons for leaving.
Education Section The form includes an education section where applicants circle their highest completed year of schooling.
References Employees must provide three references who can vouch for their background and character.
Licenses and Certificates A section exists for listing any licenses or certificates the employee may hold that are relevant to the job.
Verification of Information A signature at the end of the form certifies that the information provided is true and can be verified.
Contact Information Employees must provide their address and telephone number, as well as that of a nearest living relative.

Guidelines on Utilizing Personnel Record

Completing the Personnel Record form is an essential step in the onboarding process. This document gathers important personal and professional information, which helps ensure a smooth experience in your new position. Follow the steps outlined below to fill out the form accurately.

  1. Begin by writing the date at the top of the form.
  2. Fill in the name of the facility and its address.
  3. Enter the facility file number.
  4. In the first section, provide your personal name (last, first, and middle), current telephone number, and address.
  5. Indicate whether you are 18 years of age or older by marking the appropriate box.
  6. If you are under 18, please state your age.
  7. Optionally, provide your social security number for identification purposes.
  8. Record the date of your last physical examination and the date of your last TB test.
  9. Answer whether you have ever been employed under a different name by marking yes or no. If yes, list all names used.
  10. Indicate if you possess a valid California driver’s license, and check accordingly.
  11. If your driver’s license has ever been suspended or revoked, mark yes and provide an explanation on the back of the form.
  12. Fill in the details for your nearest living relative, including name, telephone number, relationship, and address.
  13. Next, provide information about your position title, salary, hours, date of employment, and name of your supervisor.
  14. In the previous employment section, list your most recent job first, including the name and address of the employer, telephone number, job title and type of work, reason for leaving, and the dates of employment.
  15. For the education section, circle the highest year completed. If currently enrolled in a high school completion course, check yes and provide the expected completion date.
  16. List any employment-related education courses you've completed or are currently enrolled in, including course title, name of school, and credits.
  17. Continue listing your education by providing the name of the university, college, or business school, major subject, number of years attended, units completed, and any degrees or certificates earned.
  18. Provide references by listing three individuals who can vouch for your background and abilities. Include their names, addresses, telephone numbers, and their relationship to you.
  19. In the qualifications section, list any licenses or certificates you hold and the names of any professional associations you belong to.
  20. Finally, sign and date the form to certify that all information provided is true and correct.

What You Should Know About This Form

What is the purpose of the Personnel Record form?

The Personnel Record form serves to collect essential information about employees working within the California Department of Social Services. This form captures details such as personal identification, employment history, educational background, and professional qualifications. It ensures that the organization maintains accurate and up-to-date records for personnel management and compliance with state regulations.

Who needs to fill out the Personnel Record form?

All employees at the California Department of Social Services are required to complete the Personnel Record form. This includes new hires as well as existing employees who may need to update their information. It is crucial for each employee to provide details pertaining to their employment history and qualifications to facilitate an accurate personnel file.

Is providing my Social Security number mandatory on the form?

Providing your Social Security number on the Personnel Record form is voluntary. It is requested only for identification purposes. If you do choose to provide this information, ensure it is accurate, as it may be used for verification requirements within the agency. However, if you do not wish to disclose your Social Security number, you are not required to do so.

Are there options for addressing gaps in employment history on the form?

If there are gaps in your employment history, it is advisable to be honest and provide a brief explanation if possible. The form allows you to list your most recent jobs first. You may also attach a separate page if additional space is needed to detail your previous roles or explain any employment gaps. Transparency can help present your background in a thorough and accurate manner.

What happens if I do not possess a driver's license?

If you do not have a valid California driver's license, you can simply answer “No” on the relevant question of the form. This information is requested to evaluate your qualifications for specific roles that may require driving as part of job duties. Lack of a driver's license will not disqualify you from employment; however, it may affect your eligibility for certain positions.

What should I do if I need to update my Personnel Record later?

If an update to your Personnel Record is necessary in the future, you should communicate with your supervisor or human resources department. They will provide guidance on how to revise your information formally. Keeping your record current is important, as it reflects your most accurate status regarding employment, qualifications, and personal data.

Common mistakes

Filling out the Personnel Record form accurately is essential for ensuring a smooth hiring process. However, many individuals make common mistakes that can lead to delays or complications. Understanding these pitfalls can foster better outcomes.

One common mistake is failing to provide complete personal information. The form requires a full name, including last, first, and middle initials, as well as a correct address. Omitting vital details can result in verification issues later on, prolonging the hiring process.

Another frequent error involves the inaccurate reporting of age. Applicants must confirm they are 18 or older. Those who mistakenly indicate otherwise may face automatic disqualification from certain positions. It is crucial to accurately represent one's age.

When it comes to employment history, errors often arise from incomplete listings of previous jobs. Listing the most recent position first is imperative. Furthermore, failing to provide the reason for leaving each position can lead to questions from hiring personnel, thereby complicating the review process.

The education section often presents challenges as well. Applicants regularly neglect to circle the highest year completed. This oversight may leave evaluators guessing about the applicant's educational qualifications. Additionally, not including expected graduation dates for current students can create ambiguity regarding one's status.

Another issue pertains to references. Many people fail to provide complete contact information for their references. This section should include names, relationships, addresses, and phone numbers. Incomplete details can impede the reference-checking process, raising concerns about the applicant's preparedness.

Licenses and certifications play a vital role in many positions, yet some individuals forget to list important credentials. Any relevant licenses or certificates should be clearly documented. Neglecting this area can obscure qualifications relevant to specific roles.

Error in social security number entry is another mistake worth noting. This information is often required, and an incorrect number could lead to complications with payroll or benefits. Always ensure the number provided matches exactly what is on official documentation.

Many applicants also overlook the section on the driver's license. Failure to disclose any past suspensions or revocations can result in disqualification from positions requiring driving responsibilities. Complete honesty in this area is necessary.

Finally, a significant mistake occurs when employees do not sign the form. The signature is a powerful affirmation of the accuracy of the provided information. Without it, the document may be considered incomplete, further delaying the application process.

By being aware of these common mistakes, individuals can approach the Personnel Record form with greater confidence and clarity, paving the way for a more efficient and successful hiring experience.

Documents used along the form

The Personnel Record form serves as a crucial document in the hiring process, collecting essential personal and employment-related information about an employee. Several other forms and documents often accompany it to support various aspects of human resources management, ensuring compliance with legal standards and promoting efficient workplace functionality. Below are nine other common forms and documents frequently used alongside the Personnel Record.

  • Employment Application: This document usually precedes the Personnel Record, capturing the applicant's work history, education, and skills. It allows employers to perform an initial assessment of candidate qualifications.
  • Offer Letter: After selecting a candidate, an offer letter outlines the terms of employment, including salary, job title, start date, and other relevant details, providing a formal agreement before onboarding.
  • W-4 Form: Employees fill this form to indicate their tax withholding preferences to their employer. Accurate completion helps ensure the correct federal income tax is deducted from wages.
  • I-9 Form: This document verifies an employee’s identity and eligibility to work in the United States. It must be completed within three days of hire, reflecting compliance with federal immigration laws.
  • Confidentiality Agreement: This agreement protects proprietary business information and outlines an employee's responsibilities regarding confidentiality. It deters potential misuse of sensitive information.
  • Direct Deposit Authorization Form: Employees use this form to authorize their employer to deposit their earnings directly into their bank account, streamlining the payment process.
  • Emergency Contact Form: This document gathers information on whom to contact in case of an emergency, ensuring that the employer can respond promptly if needed.
  • Performance Evaluation Form: Often used periodically, this form assesses employee performance, establishing criteria for recognition, promotions, or areas needing improvement.
  • Exit Interview Form: This form is completed when an employee resigns. It gathers feedback about the work environment and the reasons for leaving, which can be vital for future retention strategies.

These forms and documents collectively enhance the employee management process, ensuring that both the employer and the employee are aligned on expectations, responsibilities, and compliance requirements. Familiarizing oneself with these documents can greatly improve communication and efficiency within any organization.

Similar forms

  • Job Application Form: Similar to the Personnel Record form, a job application gathers personal, educational, and employment information from applicants seeking employment. Both documents require candidates to provide details relevant to their qualifications and background.

  • Employee Onboarding Checklist: This checklist is used during the hiring process to ensure all necessary documentation is completed, including personal identification and employment history, much like the Personnel Record form.

  • I-9 Employment Eligibility Verification: The I-9 form confirms an employee's identity and authorization to work in the U.S. It shares the need for personal details and can contain similar inquiries about prior names.

  • W-4 Employee's Withholding Certificate: This form is essential for tax purposes, requesting personal information such as name and Social Security number, paralleling the required data on the Personnel Record form.

  • Performance Evaluation Form: This document assesses an employee's job performance and qualifications, similar to the Personnel Record's focus on educational and professional background.

  • Reference Check Form: Employers use this document to gather information about an employee's character and work ethic. It often correlates with the references section in the Personnel Record form.

  • Background Check Authorization Form: This form allows employers to conduct a background check, requesting personal details that also appear on the Personnel Record form, such as previous names and addresses.

  • Health History Questionnaire: Employees may be asked to complete this form for health-related assessments. Like the Personnel Record, it collects information regarding physical exams and health status.

  • Professional License Application: This application necessitates personal information, educational qualifications, and employment history, resembling the documentation required in the Personnel Record form.

  • Exit Interview Form: Used when an employee leaves, this form gathers information about their employment experience and background, reflecting similar inquiries found in the Personnel Record.

Dos and Don'ts

When filling out the Personnel Record form, consider these guidelines:

  • Do provide accurate and complete information in every section.
  • Don't leave any required fields blank; incomplete forms may delay processing.
  • Do double-check your contact information for accuracy.
  • Don't use abbreviations or nicknames; use your full legal name.
  • Do ensure that any prior employment is listed chronologically, starting with the most recent.

Following these tips can help make the process smoother and more efficient.

Misconceptions

There are several misconceptions surrounding the Personnel Record form used by the California Department of Social Services. Below are five common misunderstandings and their clarifications.

  • It is mandatory to provide a Social Security number. While you can voluntarily provide your Social Security number for identification, it is not a requirement to submit the Personnel Record form.
  • You must be 18 years old to apply. The form inquires about your age, but applicants under 18 can still fill it out. If you are younger, you need to indicate your age on the form.
  • All previous names must be disclosed. You only need to list a previous name if you have ever been employed under a different name. If you have not, you can simply select "No".
  • Completing the education section is optional. This section is important for employers to gauge your educational background. Providing this information helps them make informed decisions about your qualifications.
  • The references provided will only be contacted if hired. Employers may reach out to references during the hiring process, not just after an offer is made. Being truthful about your references is crucial.

These clarifications should help demystify the Personnel Record form and create a better understanding of its requirements. If you have further questions, it is wise to consult with HR or a legal professional.

Key takeaways

Filling out the Personnel Record form is a vital step in the employment process. Here are some key takeaways to consider:

  • Complete All Sections: Ensure that every section of the form is filled out thoroughly. Missing information can delay the hiring process.
  • Be Honest About Your Background: Any discrepancies in your information, especially regarding employment history and qualifications, may lead to issues later on. Honesty is crucial.
  • Include References: Choose references who can speak positively about your character and abilities. Their insights can greatly influence the hiring decision.
  • Understand Verification Permissions: By signing the form, you authorize the employer to verify your information. Be prepared for this step, as it confirms the accuracy of what you provided.