### Declaration for Federal Employment

Form Approved OMB No. 3206-0182

*Instructions*

> The information collected on this form is used to determine your
> acceptability for Federal and Federal contract employment and your
> enrollment status in the Government\'s Life Insurance program. You may
> be asked to complete this form at any time during the hiring process.
> Follow instructions that the agency provides. If you are selected,
> before you are appointed you will be asked to update your responses on
> this form and on other materials submitted during the application
> process and then to recertify that your answers are true.
>
> All your answers must be truthful and complete**. A false statement on
> any part of this declaration or attached forms or sheets may be
> grounds for not hiring you, or for firing you after you begin work.
> Also, you may be punished by a fine or imprisonment (U.S. Code, title
> 18, section 1001)**.
>
> Either type your responses on this form or print clearly in dark ink.
> If you need additional space, attach letter-size sheets (8.5\" X 11
> \"). Include your name, Social Security Number, and item number on
> each sheet. We recommend that you keep a photocopy of your completed
> form for your records.

# Privacy Act Statement

> The Office of Personnel Management is authorized to request this
> information under sections 1302, 3301, 3304, 3328, and 8716 of title
> 5, U. S. Code. Section 1104 of title 5 allows the Office of Personnel
> Management to delegate personnel management functions to other Federal
> agencies. If necessary, and usually in conjunction with another form
> or forms, this form may be used in conducting an investigation to
> determine your suitability or your ability to hold a security
> clearance, and it may be disclosed to authorized officials making
> similar, subsequent determinations.
>
> Your Social Security Number (SSN) is needed to keep our records
> accurate, because other people may have the same name and birth date.
> Public Law 104-134 (April 26, 1996) asks Federal agencies to use this
> number to help identify individuals in agency records. Giving us your
> SSN or any other information is voluntary. However, if you do not give
> us your SSN or any other information requested, we cannot process your
> application. Incomplete addresses and ZIP Codes may also slow
> processing.
>
> ROUTINE USES: Any disclosure of this record or information in this
> record is in accordance with routine uses found in System Notice
> OPM/GOVT-1, General Personnel Records. This system allows disclosure
> of information to: training facilities; organizations deciding claims
> for retirement, insurance, unemployment, or health benefits; officials
> in litigation or administrative proceedings where the Government is a
> party; law enforcement agencies concerning a violation of law or
> regulation; Federal agencies for statistical reports and studies;
> officials of labor organizations recognized by law in connection with
> representation of employees; Federal agencies or other sources
> requesting information for Federal agencies in connection with hiring
> or retaining, security clearance, security or suitability
> investigations, classifying jobs, contracting, or issuing licenses,
> grants, or other benefits; public and private organizations, including
> news media, which grant or publicize employee recognitions and awards;
> the Merit Systems Protection Board, the Office of Special Counsel, the
> Equal Employment Opportunity Commission, the Federal Labor Relations
> Authority, the National Archives and Records Administration, and
> Congressional offices in connection with their official functions;
> prospective non-Federal employers concerning tenure of employment,
> civil service status, length of service, and the date and nature of
> action for separation as shown on the SF 50 (or authorized exception)
> of a specifically identified individual; requesting organizations or
> individuals concerning the home address and other relevant information
> on those who might have contracted an illness or been exposed to a
> health hazard; authorized Federal and non-Federal agencies for use in
> computer matching; spouses or dependent children asking whether the
> employee has changed from a self-and-family to a self-only health
> benefits enrollment; individuals working on a contract, service,
> grant, cooperative agreement, or job for the Federal government;
> non-agency members of an agency\'s performance or other panel; and
> agency-appointed representatives of employees concerning information
> issued to the employees about fitness-for-duty or agency-filed
> disability retirement procedures.
>
> *Public Burden Statement*
>
> Public burden reporting for this collection of information is
> estimated to vary from 5 to 30 minutes with an average of 15 minutes
> per response, including time for reviewing instructions, searching
> existing data sources, gathering the data needed, and completing and
> reviewing the collection of information. Send comments regarding the
> burden estimate or any other aspect of the collection of information,
> including suggestions for reducing this burden, to the U.S. Office of
> Personnel Management, Reports and Forms Manager (3206-0182),
> Washington, DC 20415-7900. The OMB number, 3206-0182, is valid. OPM
> may not collect this information, and you are not required to respond,
> unless this number is displayed.
>
> U.S. Office of Personnel Management
>
> 5 U.S.C. 1302,3301,3304,3328 & 8716

NSN 7540-01-368-7775

Optional Form 306

Revised January 2001

Previous editions obsolete and unusable

+------------------------------------+---------------------------------+
| 1\. Full Name (First, middle,      | 2\. Social Security Number      |
| last)                              |                                 |
|                                    | -                               |
| -                                  |                                 |
+------------------------------------+---------------------------------+
| 3\. Place of Birth (Include city   | 4\. Date of Birth (MM/DD/YYYY)  |
| and state or country)              |                                 |
|                                    | -                               |
| -                                  |                                 |
+------------------------------------+---------------------------------+
| 5\. Other Names Ever Used (For     | 6\. Phone Numbers (Include area |
| example, maiden name, nickname,    | codes)                          |
| etc)                               |                                 |
|                                    | Day                             |
+------------------------------------+---------------------------------+
|                                    | Night                           |
+------------------------------------+---------------------------------+

7a. Are you a male born after December 31, 1959? \_\_\_ YES \_\_\_ NO If
"NO" skip 7b and 7c. If "YES" go to 7b.

7b. Have you registered with the Selective Service System? \_\_\_ YES
\_\_\_ NO If "NO" go to 7c.

7c. If "NO", describe your reason(s) in item #16.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

*(Sign in ink)*

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

*(Sign in ink)*

\_\_\_ YES \_\_\_ NO \_\_\_ Don't Know