Cal. Code Regs. Tit. 5, Div. 4, Chap. 1, Art. 14 C.5

Current through Register 2024 Notice Reg. No. 25, June 21, 2024

Attachment C.5

FORM IS OPTIONAL - INFORMATION IS STILL REQUIRED FOR APPLICATION PROCESS

APLE for District Interns 2xxx-xx Selected Applicants

School Name:__________

	NAME	*SOCIAL SECURITY #	TEACHING SERVICE AREA
1.	___________________________	___________________________	___________________________
2.	___________________________	___________________________	___________________________
3.	___________________________	___________________________	___________________________
4.	___________________________	___________________________	___________________________
5.	___________________________	___________________________	___________________________
6.	___________________________	___________________________	___________________________
7.	___________________________	___________________________	___________________________
8.	___________________________	___________________________	___________________________
9.	___________________________	___________________________	___________________________
10.	___________________________	___________________________	___________________________
11.	___________________________	___________________________	___________________________
12.	___________________________	___________________________	___________________________
13.	___________________________	___________________________	___________________________
14.	___________________________	___________________________	___________________________
15.	___________________________	___________________________	___________________________
16.	___________________________	___________________________	___________________________
17.	___________________________	___________________________	___________________________
18.	___________________________	___________________________	___________________________
19.	___________________________	___________________________	___________________________
20.	___________________________	___________________________	___________________________
21.	___________________________	___________________________	___________________________
22.	___________________________	___________________________	___________________________
23.	___________________________	___________________________	___________________________
24.	___________________________	___________________________	___________________________
25.	___________________________	___________________________	___________________________

* Please see attached State of California Information Practices Act (IPA) of 1977 & Use of Your Social Security Number

Cal. Code Regs. Tit. 5, Div. 4, Chap. 1, Art. 14 C.5