FORM |
EXPLANATION |
| AO 75a |
Term Chambers Law Clerk Appointment and Leave Certification
Chambers Law Clerk appointments of
less than four years are considered term appointments
and are not eligible for coverage under the Federal
Employees Retirement System. Chambers Law Clerks are generally
not covered under the Judicial Leave Act unless
the appointing officer has indicated otherwise.
Please sign and date the form where indicated. Do
not mark any of the boxes on the form. |
| AO 75b |
Staff Attorney Appointment Certification Staff Law Clerk appointments of less than four years are considered term appointments and are not eligible for coverage under the Federal Employees Retirement System. Staff Law Clerks are covered under the Judicial Leave Act. Please sign and date the form where indicated. |
| AO 78 |
Application for Judicial Branch Federal Employment Please
complete the Application as completely as possible making sure
to include any prior federal work experience. Incomplete
data could affect the appointment grade or delay the processing
of the appointment, thus delaying receipt of your first salary
check. For date(s) of degrees received, date(s) of employment or date(s) of bar admittance (if applicable), please indicate the month, date and year. Also, please indicate actual hours worked and do not list ranges. |
| AO 78a |
United States Courts Appointment - Oath of Office Do not write anything on Section A of the AO78a; these portions are completed by the Human Resources Department upon receipt of your completed forms. On Section A you should print your name, as you want it to appear on payroll. The Oath of Office should be taken and signed in the presence of a notary public. |
| form AO 78b EEO Reporting Form |
Voluntary Race/Ethnicity, Gender, & Disability Identification form |
| AO 80 |
Clerks' and Deputy Clerks' Oath Write your name as you would like it to appear on payroll and sign where indicated. (Clerk's Office Staff only) |
| AO 0162 | Election to Participate in the Judicial Survivors’ Annuity System (JSAS) [You may need to download the form, save it to your computer and then fill it out.] |
| Background Investigation Form |
Background Required Information Form All employees and volunteers in federal courts must undergo mandatory background checks. Please complete this form where indicated. |
| Emergency Contact Form | Emergency contact form: confidential and strictly for emergency purposes only. |
| FMS
2231 |
Fast Start Direct Deposit Form All employees are required to have their salary check sent directly to a financial institution by electronic fund transfer. The Fast Start Direct Deposit Form must be submitted to the Human Resources Department by the end of your first pay period. It is your option whether you would like to provide a voided check. |
| I-9 |
Employment Eligibility Verification Instructions for completing the form and a list of acceptable documents used to establish identity are attached. Complete page one and sign where indicated. Send our office advance copies of the documents you plan on using and be prepared to produce the original documents within the first three days of your employment. Our office will complete page two of the form. |
| SF
144 |
Statement of Prior Federal Service |
| SF
1152 |
Designation of Beneficiary - Unpaid Compensation of Deceased Civilian Employee A page of examples of designations is included on the second page of the form. A duplicate copy of the form and instructions for completing the form are attached as well. |
| SF
2808 |
• Designation of Beneficiary - CSRS |
| SF
2809 [If you experience difficulty in opening this form, right click on the link and 'Save Target As' to save a copy to your computer rather than trying to open it directly in your browser.] |
Federal
Employees Health Benefits Election Form Please visit the Judiciary Benefits Center to make your health insurance elections. See the Health Insurance area of this web site for links to more detailed health benefits information. Using the comparison chart booklet and individual plan booklets, select the health plan and option that best fits your health insurance needs. You have 60 days from the first day of employment to elect health insurance coverage. You must be on the payroll for at least one day before you are eligible for health insurance. Your health insurance will become effective the first Monday of the following pay period in which you make your election. If you decline coverage at this time or wish to change coverage at a later date, you must wait for a qualifying life event and use this form or wait until the next open season enrollment held in November of each year. Changes made during open season become effective the beginning of the first full pay period of the coming year. |
| SF
2817 |
Life
Insurance Election Form Please visit the Judiciary Benefits Center to make your life insurance elections. See the Life Insurance area of this web site for links to more detailed life insurance benefits information. Federal Employee Group Life Insurance (FEGLI) Basic Coverage is term insurance with 1/3 of the cost paid for by the Federal Government. All eligible employees are automatically enrolled in the Basic Coverage from the date of entrance on duty unless coverage is waived. Elections must be made before the end of the first pay period of employment to not have a premium deduction. You have up to 60 days from your first day of employment to elect further options. If you do not want life insurance coverage you must log into the Judiciary Benefits Center and waive coverage. |
| SF 3102 | • Designation of Beneficiary - FERS |
| TSP
1 |
Thrift
Savings Plan Election Form Please visit the Judiciary Benefits Center to make your TSP elections. |
| TSP 1C |
Catch-up Contribution Election Form Please visit the Judiciary Benefits Center to make your TSP elections. |
| TSP 3 |
Thrift Savings Plan Designation of Beneficiary |
| TSP 25 |
Automatic Enrollment Refund Request |
| W-4 federal |
Federal
Employee's Withholding Certificate Form |
| W
- 4 state |
Please list the address where you will be residing during employment on the state tax forms. |