State Assembly
Vetting Request

Request vetting for a person interested in a State Assembly position, document the requesting party, and provide the information needed for review.

Begin the Vetting Request

Vetting Intake

Tell CMS who is requesting vetting and who is being vetted.

Fields marked with an asterisk are required. After submitting, keep the CMS reference number with the completed questionnaire.

Requesting party

Identify the person or State Assembly representative submitting this vetting request.

Requester’s full name *State Assembly or organization *Requester’s title or role *Relationship to the person being vetted *Requester phone number *Requester email address *Requester’s complete mailing address *

Person being vetted

Full lawful name *Date of birth *Political status *State *County or parish *State Assembly position of interest *Complete mailing address *Phone number *Email address *Other names previously used

History and suitability information

Provide factual information relevant to the requested position. If an item does not apply, enter “None known.” Do not include unverified accusations as established fact.

Background and personal-history summary *Employment and service history *Known criminal, civil, disciplinary, or ethics matters *Qualifications and reason for seeking the position *Known conflicts of interest or matters needing explanation

Additional informationAdditional notes

Requester’s declaration and electronic signature

By signing below, the requester confirms that the person being vetted authorized this request and the sharing of the information provided here. This initial request does not replace any separate authorization required by applicable law or a background-check provider.

Type the requester’s full name as the electronic signature *Date signed *

I certify that the information in this request is accurate to the best of my knowledge. *I confirm that the person being vetted authorized this request and consented to CMS receiving and reviewing the information provided. *I confirm that the person being vetted understands that CMS may conduct a background review and that separate authorization may be required. *

State AssemblyVetting Request

Tell CMS who is requesting vetting and who is being vetted.

State Assembly
Vetting Request