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Retired State Employee List

Please choose Retired State Employee with a General or Law Enforcement Option.

* Name:
* Email:
* SSN (without dashes):
* Address 1:
Address 2:
* City, State, Zip:
* Home Phone:
Job Title:

* Last Employment Date (mm/dd/yyyy):
Here is an image of a small calendar
***If you are requesting an extension on the reemployment/rehire list then we MUST have a written explanation below of related work experience or courses taken which have maintained your skills for employment.***
        * required fields