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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. 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.

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 B you should print your name, as you want it to appear on payroll, just above the Oath of Office. The Oath of Office should be taken and signed in the presence of a notary public or your appointing officer.

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)

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.

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

An 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

[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 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. 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 31 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 31 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.
SF 2823 • Life Insurance Designation of Beneficiary: SF 2823
TSP 1



Thrift Savings Plan Election Form

Please see the Retirement area of this web site for links to more detailed TSP information.
W-4
federal



Federal Employee's Withholding Certificate Form

Self Explanatory

W - 4
state










• IL

IL Dept. of Revenue
Withholding Tax Form
 
• IN

IN Dept. of Revenue
Withholding Tax Form
 
• MO

MO Dept. of Revenue
Withholding Tax Form
 
• WI

WI Dept. of Revenue
Withholding Tax Form