***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    | NSN 7540-01-368-7775     | Optional    |
| Management                  |                          | Form 306    |
|                             |                          |             |
|                             |                          | Revised     |
|                             |                          | January     |
|                             |                          | 2001        |
|                             |                          |             |
|                             |                          | Previous    |
|                             |                          | editions    |
|                             |                          | obsolete    |
|                             |                          | and         |
|                             |                          | unusable    |
+-----------------------------+--------------------------+-------------+
| 5 U.S.C. 1302, 3301, 3304,  |                          |             |
| 3328 & 8716                 |                          |             |
+-----------------------------+--------------------------+-------------+

> ![](media/image1.png){width="0.8097222222222222in"
> height="0.4131944444444444in"}**Declaration for Federal Employment**
> Form Approved
>
> OMB No. 3206-0182

***GENERAL INFORMATION***

+---+-----------------------------------------+---+----------------------+
| * | **FULL NAME** *(First, middle, last)*   | * | **SOCIAL SECURITY    |
| * |                                         | * | NUMBER**             |
| 1 | *‹*                                     | 2 |                      |
| . |                                         | . | **‹**                |
| * |                                         | * |                      |
| * |                                         | * |                      |
+---+-----------------------------------------+---+----------------------+
| * | **PLACE OF BIRTH** *(Include city and   | * | **DATE OF BIRTH**    |
| * | state or country)*                      | * | *(MM/DD/YYYY)*       |
| 3 |                                         | 4 |                      |
| . |                                         | . |                      |
| * |                                         | * |                      |
| * |                                         | * |                      |
+---+-----------------------------------------+---+----------------------+
|   | *‹*                                     |   | *‹*                  |
+---+-----------------------------------------+---+----------------------+
| * | **OTHER NAMES EVER USED** *(For         | * | **PHONE NUMBERS**    |
| * | example, maiden name, nickname, etc)*   | * | *(Include area       |
| 5 |                                         | 6 | codes)*              |
| . |                                         | . |                      |
| * |                                         | * |                      |
| * |                                         | * |                      |
+---+-----------------------------------------+---+----------------------+

> Night ‹![](media/image2.png){width="0.24305555555555555in"
> height="0.2in"}![](media/image2.png){width="0.24305555555555555in"
> height="0.2in"}![](media/image3.png){width="0.24027777777777778in"
> height="0.2in"}![](media/image4.png){width="0.24027777777777778in"
> height="0.2in"}![](media/image2.png){width="0.24305555555555555in"
> height="0.2in"}![](media/image2.png){width="0.24027777777777778in"
> height="0.2in"}

***Selective Service Registration***

If you are a male born after December 31, 1959, and are at least 18
years of age, civil service employment law (5 U.S.C. 3328) requires that
you must register with the Selective Service System, unless you meet
certain exemptions.

***Background Information***

**For all questions, provide all additional requested information under
item 16 or on attached sheets.** The circumstances of each event you
list will be considered. However, in most cases you can still be
considered for Federal jobs.

For questions 9,10, and 11, your answers should include convictions
resulting from a plea of *nolo contendere* (no contest), but omit (1)
traffic fines of \$300 or less, (2) any violation of law committed
before your 16th birthday, (3) any violation of law committed before
your 18th birthday if finally decided in juvenile court or under a Youth
Offender law, (4) any conviction set aside under the Federal Youth
Corrections Act or similar state law, and (5) any conviction for which
the record was expunged under Federal or state law.

9\. During the last 10 years, have you been convicted, been imprisoned,
been on probation, or been on parole? (Includes felonies, firearms or
explosives violations, misdemeanors, and all other offenses.) *If
\"YES,\" use item 16 to provide the date, explanation of the violation,
place of occurrence, and the name and address of the police department
or court involved.*![](media/image5.png){width="0.8097222222222222in"
height="0.4131944444444444in"}

10\. Have you been convicted by a military court-martial in the past 10
years? *(If no military service, answer \"NO.\") If \"YES,\" use item 16
to provide the date, explanation of the violation, place of occurrence,
and the name and address of the military authority or court
involved.*![](media/image6.png){width="0.8333333333333334in"
height="0.43680555555555556in"}

11\. Are you now under charges for any violation of law? *If \"YES,\"
use item 16 to provide the date, explanation of the violation, place of
occurrence, and the name and address of the police department or court
involved.*![](media/image7.png){width="0.8263888888888888in"
height="0.4097222222222222in"}

12\. During the last 5 years, have you been fired from any job for any
reason, did you quit after being told that
you![](media/image8.png){width="0.8263888888888888in"
height="0.4201388888888889in"}

> would be fired, did you leave any job by mutual agreement because of
> specific problems, or were you debarred from Federal employment by the
> Office of Personnel Management or any other Federal agency? *If
> \"YES,\" use item 16 to provide the date, an explanation of the
> problem, reason for leaving, and the employer\'s name and address.*

*13. Are you delinquent on any Federal debt? (Includes delinquencies
arising from Federal taxes, loans, overpayment of **YES** benefits, and
other debts to the U.S. Government, plus defaults of Federally
guaranteed or insured loans such as student and home mortgage loans.)*
If \"YES,\" use item 16 to provide the type, length, and amount of the
delinquency or default, and steps that you are taking to correct the
error or repay the debt.

+-----------------------------+--------------------------+------------+
| U.S. Office of Personnel    | NSN 7540-01-368-7775     | Optional   |
| Management                  |                          | Form 306   |
+-----------------------------+--------------------------+------------+
| 5 U.S.C. 1302, 3301, 3304,  |                          | Revised    |
| 3328 & 8716                 |                          | January    |
|                             |                          | 2001       |
|                             |                          |            |
|                             |                          | Previous   |
|                             |                          | editions   |
|                             |                          | obsolete   |
|                             |                          | and        |
|                             |                          | unusable   |
+-----------------------------+--------------------------+------------+

> **Declaration for Federal
> Employment**![](media/image9.png){width="0.8298611111111112in"
> height="0.4in"}![](media/image10.png){width="1.7868055555555555in"
> height="0.9263888888888889in"}

***Additional Questions***

14\. Do any of your relatives work for the agency or government
organization to which you are submitting this form? (Include: father,
mother, husband, wife, son, daughter, brother, sister, uncle, aunt,
first cousin, nephew, niece, father-in-law,mother-in-law, son-in-law,
daughter-in-law, brother-in-law, sister-in-law, stepfather, stepmother,
stepson, stepdaughter, stepbrother, stepsister, half brother, and half
sister.) *If \"YES,\" use item 16 to provide the relative\'s name,
relationship, and the department, agency, or branch of the Armed Forces
for which your relative works.*

> 15\. Do you receive, or have you ever applied for, retirement pay,
> pension, or other retired pay based on military, Federal civilian, or
> District of Columbia Government
> service?![](media/image11.png){width="0.8368055555555556in"
> height="0.40694444444444444in"}

***Continuation Space / Agency Optional Questions***

> 16\. Provide details requested in items 7 through 15 and 18c in the
> space below or on attached sheets. Be sure to identify attached sheets
> with your name, Social Security Number, and item number, and to
> include ZIP Codes in all addresses. If any questions are printed
> below, please answer as instructed *(these questions are specific to
> your position and your agency is authorized to ask them).*

***Certifications / Additional Questions***

***APPLICANT: If you are applying for a position and have not yet been
selected,*** carefully review your answers on this form and any attached
sheets. When this form and all attached materials are accurate, read
item 17, and complete 17a.

***APPOINTEE: If you are being appointed,*** carefully review your
answers on this form and any attached sheets, including any other
application materials that your agency has attached to this form. If any
information requires correction to be accurate as of the date you are
signing, make changes on this form or the attachments and/or provide
updated information on additional sheets, initialing and dating all
changes and additions. When this form and all attached materials are
accurate, read item 17, complete 17b, read 18, and answer 18a, 18b, and
18c as appropriate.

17\. **I certify** that, to the best of my knowledge and belief, all of
the information on and attached to this Declaration for Federal
Employment, including any attached application materials, is true,
correct, complete, and made in good faith. **I understand that a false
or fraudulent answer to any question or item on any part of this
declaration or its attachments may be grounds for not hiring me, or for
firing me after I begin work, and may be punishable by fine or
imprisonment. I understand** that any information I give may be
investigated forpurposes of determining eligibility for Federal
employment as allowed by law or Presidential order. **I consent** to the
release of information about my ability and fitness for Federal
employment by employers, schools, law enforcement agencies, and other
indi viduals and organizations to investigators, personnel specialists,
and other authorized employees or representatives of the Federal
Government. **I understand** that for financial or lending institutions,
medical institutions, hospitals, health care professionals, and some
other sources of information, a separate specific release may be needed,
and I may be contacted for such a release at a later date.

17a. Applicant\'s Signature: *(Sign in ink)*

17b. Appointee\'s Signature: *(Sign in ink)*

18\. **Appointee (Only respond if you have been employed by the Federal
Government before):** Your elections of life insurance during previous
Federal employment may affect your eligibility for life insurance during
your new appointment. These questions are asked to help your personnel
office make a correct determination.

MM / DD / YYYY

> 18a. When did you leave your last Federal job? DATE:

18b. When you worked for the Federal Government the last time, did you
waive Basic Life Insurance or any type of optional life insurance?

18c. If you answered \"YES\" to item 18b, did you later cancel the
waiver(s)? If your answer to item 18c is \"NO,\" use item 16 to identify
the type(s) of insurance for which waivers were not canceled.

+-----------------------------+--------------------------+------------+
| U.S. Office of Personnel    | NSN 7540-01-368-7775     | Optional   |
| Management                  |                          | Form 306   |
+-----------------------------+--------------------------+------------+
| 5 U.S.C. 1302, 3301, 3304,  |                          | Revised    |
| 3328 & 8716                 |                          | January    |
|                             |                          | 2001       |
|                             |                          |            |
|                             |                          | Previous   |
|                             |                          | editions   |
|                             |                          | obsolete   |
|                             |                          | and        |
|                             |                          | unusable   |
+-----------------------------+--------------------------+------------+