TCEQ 10267 (Rev-9/2015)
Previous Texas State & Texas State
University Employment
Employee Name:
Social Security #: Date Employed by TCEQ:
Certain fringe benefits to state employees are based on years of service as a state employee.
It is imperative that each employee provides accurate service records that are authentic and
accurate from all Texas state agencies and Texas state universities that the employee was
previously employed.
Please indicate below the dates of any previous employment with any Texas state agency
and/or Texas state university prior to your employment with TCEQ.
I do not have any previous state employment with any Texas state agency or Texas
state university.
Signature:
Date:
If you have questions on how to fill out this form or about Human Resources & Staff Services,
please contact us at 512-239-0102.
Individuals are entitled to request and review their personal information that the agency gathers
on its forms. They may also have any errors in their information corrected. To review such
information, contact us at 512-239-3282.
Name of Texas State Agency/Texas State University
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