Medical clearance is required prior to employment in state service.
Present employment: do not leave your present employment to accept a position in state service until you have been specifically notified to report for work.
YES answers: YES answers to questions 1 - 43 must be explained in the space provided on the back of this form.
Return it: return this completed form to the hiring agency unless advised otherwise by the hiring agency.
Misrepresentation: any misrepresentation or material omission may be cause for dismissal.
| Question | Answer |
|---|---|
| Form Name | Form STD 610 |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 306 |
| Avg. time to fill out | 51 min |
| Edition | 10/2019 |
| Issuing agency | State of California, Department of Human Resources |
| Where to return | The hiring agency |
| Other names | STD 610, STD 610, STD610, Form STD 610, Form 610, Health Questionnaire (And Physician's Report) |
| Official source | Form STD 610 (Rev 10/2019), California Department of Human Resources |
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