FORM |
EXPLANATION |
| AO75a |
Type
of Appointment Checklist - Law Clerk to Federal Judge
Law Clerk appointments of
less than four years are considered term appointments
and are not eligible for coverage under the Federal
Employees Retirement System. |
| AO75b |
Type of Appointment Checklist - Staff Attorney (Michael Fridkin's Office) Staff
Attorney appointments of less than four years are considered
term appointments and are not eligible for coverage under the
Federal Employees Retirement System. |
| AO78 |
Application for Judicial Branch Federal Employment Please
complete the Application as fully as possible making sure
to include any prior federal work experience. If you do not know
where you will be residing while employed with the court, please
leave the address line blank and we will insert the address and
room number for the office where you will be employed. Incomplete
data could affect the appointment grade or delay the processing
of the appointment, thus delaying receipt of your first salary
check. |
| AO78a |
United States Courts Appointment - Oath of Office Do not write anything on Section A of the AO78a; this portion is completed by the Human Resources Department. On Section B you should print your name, as you want it to appear on payroll, just above the Oath of Office. The Oath of Office must be taken and signed in the presence of a notary public, prior to sending it in to the Human Resources Office. Failure to send in a properly signed and notarized form may delay receipt of your first paycheck. |
| 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. |
| EEO Reporting Form | U.S. Court of Appeals - EEO Reporting Form Self-Identification Form - Race/Ethnic, Gender and Disability |
| ELMO |
Please sign this form where indicated, keeping your signature within the allotted area |
| 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. |
| I-9 |
Employment Eligibility Verification A
list of acceptable documents used to establish identity and employment
eligibility is listed on the second page of the form. Instructions
for completing the form are attached as well. |
| SF
144 |
Statement of Prior Federal Service Complete all sections of this form and return to our office ONLY if you have had prior federal work experience |
| 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 2809 form [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 This
form is due 60 days from your entrance on
duty. Please see the Health Insurance area of this web site
SF 2809 Form Instructions 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. If choosing an HMO, you must select a Primary Care Physician and indicate that selection on the bottom of your enrollment form. 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 this office receives your completed registration form. If you decline coverage at this time or wish to change coverage at a later date, you must wait until the next open season enrollment held in November of each year. Changes made during this period become effective the beginning of the first full pay period of the coming year. |
| SF
2817 |
Life
Insurance Election Form This form is due 60 days from your entrance on duty. Please 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 as indicated in the general instructions. You have up to 60 days from your first day of employment to elect or waive basic coverage or choose further options. If you do not want life insurance coverage you must complete the form and sign the waiver. If the form with signed waiver is received in the Human Resources Department within the first pay period of your employment any deductions that may be taken from your first paycheck will be refunded to you. |
| • TSP-1 Election Form form instructions |
Thrift
Savings Plan Election Form You are eligible to begin regular employee payroll deductions, on a pre-tax basis, at any time during your employment. Each pay period we will deduct your contributions to the TSP from your pay check in the amount you choose. We will continue to do so until you make a new TSP election changing the amount of your contribution or stopping it. In order to begin, change, or stop your employee contribution, you must make a TSP contribution election on Form TSP-1. This form is available from Human Resources or directly from the TSP web site. Please see the Retirement area of this web site for links to more detailed TSP information. |
| • TSP-1C Catch-Up Contribution Election Form form instructions |
Thrift
Savings Plan Election Form You are eligible to make catch-up contributions if you are age 50 or older (or if you will become age 50 during the calendar year for which you are making this election), and you are already contributing a percentage or a dollar amount which will result in reaching the Internal Revenue Code (IRC) elective deferral limit by the end of the year. Catch-up contributions are in addition to your regular TSP contributions. In order to begin, change, or stop your employee contribution, you must make a TSP contribution election on Form TSP-1C. This form is available from Human Resources or directly from the TSP web site. Please see the Retirement area of this web site for links to more detailed TSP information. |
| W-4 federal |
IRS:
Internal Revenue Service Federal Employee's Withholding Certificate Form |
| W - 4 state |