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[{"$nulls":7},"BIOGRAPHY",{"$nulls":3},"THIS PAGE IS NOT TO BE RELEASED TO THE PUBLIC."]
[{"$nulls":7},"for "]
[{"$nulls":7},"ACADEMIC PERSONNEL"]
[null,"PLEASE PRINT OR TYPE",{"$nulls":14},"Mr."]
[null,"To be filled in by Department",{"$nulls":14},"Mrs."]
[{"$nulls":16},"Ms."]
[null,"Campus:","UC, Los Angeles",null,null,"Department:",{"$nulls":3},"Title(s):",{"$nulls":6},"Miss"]
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[null,"Name ",{"$nulls":10},"Optional"]
[null,null,"  Last",null,null,"First",null,"Middle",null,null,"Select One"]
[null,"Prior University Experience",{"$nulls":5},"If \"Yes\", list on the following page."]
[null,"Permanent Home Address"]
[{"$nulls":4},"Street",null,null,"City",null,"State","Zip",null,"Telephone"]
[null,"Current Home Address"]
[{"$nulls":4},"Street",null,null,"City",null,"State","Zip",null,"Telephone"]
[null,"Current Business Address"]
[{"$nulls":4},"Street",null,null,"City",null,"State","Zip",null,"Telephone"]
[null,"Date of Birth",{"$nulls":5},"Are you a citizen of the U.S.?"]
[]
[null,"Name and permanent address of person to be contacted in case of emergency:"]
[]
[null,"Name"]
[]
[null,"Street",{"$nulls":3},"City",null,"State",null,"Zip",null,"Telephone"]
[]
[null,"Relatives employed by the University"]
[{"$nulls":6},"Name",null,null,"Relationship",null,null,"Department"]
[]
[{"$nulls":6},"Name",null,null,"Relationship",null,null,"Department"]
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[{"$nulls":5},"PRIVACY NOTICE"]
[null,"The State of California Information Practices Act of 1977 (effective July 1, 1978) requires the University to provide the following information to individuals who are asked to supply  information about themselves:"]
[]
[null,"The principal reason for requesting the information on this form is for purposes of academic personnel administration and University public relations.  University policy authorizes maintenance of this information.  For academic personnel administrative purposes, furnishing all information on this form is mandatory."]
[]
[null,"With your permission, information on education, honors, awards, and/or publications may be used for University public relations purposes and therefore may be released to the public."]
[]
[null,"Individuals have the right to review their own records in accordance with Academic Personnel Manual 160.  Information on this policy can be obtained from campus or Office of the President Academic Personnel Offices.  "]
[]
[{"$nulls":5},"NONDISCRIMINATION STATEMENT"]
[null,"The University of California, in compliance with Titles VI and VII of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Sections 503 and 504 or the Rehabilitation Act of 1973, and the Age discrimination in Employment Act of 1967, does not discriminate on the basis of race, color national origin, religion,sex, handicap, or age in any of its policies, procedures or practices; nor does the University, in compliance with Section 402 of Vietnam Era Veterans Readjustment Act of 1974, and Section 12940 of the State of California Government Code, discriminate against any employees or applicants for employment because they are disable veterans or veterans of the Vietnam era, or because of the medical condition (as defined in Section 12926 of the California Government Code), their ancestry, or their marital status; nor does the University discriminate on the basis of citizenship, within the limits imposed by law or University policy; nor does the University discriminate on the basis of sexual orientation.  The nondiscrimination policy covers admissions, access and treatment in the University programs and activities, and application for the treatment of University employment.\n"]
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[null,"In conformance with University policy and pursuant to Executive Orders 11246 and 11375, Section 503 of the Rehabilitation Act of 1973, and Section 402 of the Vietnam Era Veterans Readjustment Act of 1974, the University of California is an equal opportunity employer."]
[]
[]
[null,"RETENTION PERIOD: ",null,"Record Copy - Senate Member: 5 years after separation to permanent.  Non-Senate Member: 5-10 years after separtion"]
[null,"All other Copies:  0-5 years after separation."]

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[null,"PREVIOUS APPLICABLE EMPLOYMENT",{"$nulls":9},"THIS PAGE IS NOT TO BE RELEASED TO THE PUBLIC."]
[null,"Please show a full account of your time from the date of your first academic (or otherwise relevant) employment to the present, including any periods when you may not hve been employed.  Show most recent position first, followed by prior employment.  Indicate part-time appointment and leaves of absence.  Show salary or approximate annual earning in all cases.  Please include all previous University of California employment.  You may attach supplementary information."]
[]
[{"$nulls":16},"Mr."]
[{"$nulls":16},"Mrs."]
[null,"INCLUSIVE DATES:",null,"INSTITUTION, FIRM, OR ",{"$nulls":5},"RANK, TITLE, OR POSITION",null,null,"APPROXIMATE",{"$nulls":3},"Mrs."]
[null,"MONTH AND YEAR",null,"ORGANIZATION AND LOCATION",{"$nulls":8},"ANNUAL SALARY",{"$nulls":3},"Miss"]
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[null,"FR:",{"$nulls":14},"Ms."]
[null,"TO:"]
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[null,"FR:"]
[null,"TO:"]
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[null,"FR:"]
[null,"TO:"]
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[null,"FR:"]
[null,"TO:"]
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[null,"FR:"]
[null,"TO:"]
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[null,"FR:"]
[null,"TO:"]
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[null,"FR:"]
[null,"TO:"]
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[null,"FR:"]
[null,"TO:"]
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[null,"FR:"]
[null,"TO:"]
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[null,"FR:"]
[null,"TO:"]
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[null,"FR:"]
[null,"TO:"]

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[{"$nulls":8},"Information on this page "]
[null,"Name:"]
[null,"Department:",{"$nulls":6},"be released to the public"]
[{"$nulls":8},"Initial here:"]
[]
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[null,"EDUCATION"]
[null,"DATES OF ATTENDANCE","NAME OF SCHOOL, COLLEGE, UNIVERSITY OR HOSPITAL (INTERN & RESIDENT)",null,null,"LOCATION",null,"MAJOR SUBJECT OR FIELD","DEGREES OR CERTIFICATE",null,"DATE RECEIVED"]
{"$rows_empty":9}
[null,"Please indicate areas of sub-specializaton, if any.  Also include special licenses or permits."]
{"$rows_empty":9}
[null,"Memberships:  Please list membership in scholarly societies, accreditation boards, civic organizations, etc.  You may exclude any organization the name or character of which my indicate the race, religion, or national orgin of its members."]
{"$rows_empty":9}
[null,"Honors, Awards:  Please list honors or awards such as Fulbright grants, Woodrow Wilson scholarships, special lectureships, medals,etc., and dates received."]

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[{"$nulls":8},"Information on this page "]
[null,"Name:"]
[null,"Department:",{"$nulls":6},"be released to the public"]
[{"$nulls":8},"Initial here:"]
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[null,"PUBLISHED WRITINGS and/or CREATIVE ACTIVITIES"]
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[null,"Published writings and/or creative activities may be listed here or appended separately."]
{"$rows_empty":39}
[null,"Signature",{"$nulls":7},"Date"]
[null,"NOTE:  Be sure you have checked the appropriate box and placed your initials in the spaces provide on page 3 and 4"]