AO 78 (4/22)

FEDERAL JUDICIAL BRANCH

APPLICATION FOR EMPLOYMENT

If you need additional space, continue under “Remarks” listing item number

1. Name (Last, First, Middle Initial) 2. Phone Number

3. Present Address (Street, City, State, Zip)

4. Email Address

5. Other Names Previously Used for Employment Purposes 6. Date of Birth (complete only for law enforcement positions)

GENERAL

7. Are you a U.S. Citizen? YES NO If no, give the Country of your citizenship

8. a. Were you ever a federal civilian employee? YES NO If yes, give highest civilian grade: / /

Pay Plan Grade Step

b. Are you receiving a federal civilian annuity payment? YES NO

c. Are you receiving federal severance pay? YES NO If yes, give former agency contact/telephone:

d. Have you received a federal separation incentive payment YES NO If yes, state mo/yr received and former agency contact/telephone:

in the past 5 years? 

9. Do you have any relatives who are Judges, Officers or YES NO If yes, give their names, positions, and relationships to you.

employees of the United States Courts?

10. Have you ever served on active duty with the military? YES NO (If selected, you will need to provide your DD-214 (copy 4), Certificate

of Release or Discharge from Active Duty, so that your service may be 

verified and credited) 

BACKGROUND INFORMATION

11. During the last 5 years, have you been fired from any job for

any reason, did you quit after being told that you 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?

YES NO If yes, provide in Section 17 the date, explanation of problem, reason for 

leaving, and employer’s name/address.

12. Are you delinquent on any Federal debt? (Include 

delinquencies arising from Federal taxes, loans, overpayment of

benefits, and other debts to the U.S. Government, plus defaults of

Federally guaranteed or insured loans (e.g., student loan, home 

mortgage loan)).

YES NO If yes, provide in Section 17 the type, length, and amount of 

delinquency/default, and steps being taken to correct the error/repay the debt.
Page 2 of 5 

EDUCATION

13. a. Do you have a high school diploma or G.E.D. equivalent? YES NO

 b. Name and location of colleges or universities

 attended (including law schools)

Dates Attended

Credit Hours

Degree Date Received

Grade Point

Average and/or

Q scholastic standing uarter Semester

 

 

 

 

 

14. c. Other schools or training attended (list name/location of school, dates attended, subject studied, certificates received, and other pertinent data):

JOB RELATED SKILLS, AWARDS, SPECIAL ACCOMPLISHMENTS

15. List any skills (e.g., language, computer, keyboarding speed), honors, awards, or special accomplishments (e.g., memberships in professional/honor societies, leadership 

activities, performance awards) that you believe are relevant to your ability to perform the job: 

APPLICANTS FOR LEGAL POSITIONS

16. a. Are you admitted to the Bar? YES NO If yes, list the Bar(s) to which admitted and date(s) of admission. If no, skip to 

16b.

 Is your Bar membership ACTIVE INACTIVE

 b. What was your scholastic standing in law school? UPPER 1⁄2 UPPER 1⁄3 UPPER 1⁄4

 c. Were you a member of an editorial board of law review or a 

 moot court participant? 

YES No

17. REMARKS (Use this space for continuation of answers. List the item number being explained.)

 
Page 3 of 5 

WORK EXPERIENCE

(Start with your present position and work back 10 years. Include any military service. Use additional page if necessary.)

A

Dates of Employment (mm/dd/yyyy) Number of hours 

worked per week: Exact Title of Your Position

From: To:

Salary or Earnings Pay Plan/Grade

(If in federal Service) Place of Employment

Starting $ Per City

Final $ Per State

Name and Title of Immediate Supervisor Name and Address of Employer (firm, organization, etc.)

Business Telephone: (Area Code and Phone Number)

Reason for Leaving

Description of Work

B

Dates of Employment (mm/dd/yyyy) Number of hours 

worked per week: Exact Title of Your Position

From: To:

Salary or Earnings Pay Plan/Grade

(If in federal Service) Place of Employment

Starting $ Per City

Final $ Per State

Name and Title of Immediate Supervisor Name and Address of Employer (firm, organization, etc.)

Business Telephone: (Area Code and Phone Number)

Reason for Leaving

Description of Work
Page 4 of 5 

C

Dates of Employment (mm/dd/yyyy) Number of hours 

worked per week: Exact Title of Your Position

From: To:

Salary or Earnings Pay Plan/Grade

(If in federal Service) Place of Employment

Starting $ Per City

Final $ Per State

Name and Title of Immediate Supervisor Name and Address of Employer (firm, organization, etc.)

Business Telephone: (Area Code and Phone Number)

Reason for Leaving

Description of Work

D

Dates of Employment (mm/dd/yyyy) Number of hours 

worked per week: Exact Title of Your Position

From: To:

Salary or Earnings Pay Plan/Grade

(If in federal Service) Place of Employment

Starting $ Per City

Final $ Per State

Name and Title of Immediate Supervisor Name and Address of Employer (firm, organization, etc.)

Business Telephone: (Area Code and Phone Number)

Reason for Leaving

Description of Work
Page 5 of 5 

OPTIONAL BACKGROUND INFORMATION – RESPOND ONLY IF REQUIRED BY THE VACANCY ANNOUNCEMENT

Answer questions 18, 19, and 20, only if required by the vacancy announcement. 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.

18. During the last 7 years, have you been convicted, imprisoned, on 

probation, or on parole? (Include felonies, firearms or explosives 

violations, misdemeanors, and all other offenses)

YES NO If yes, provide in Section 21 the date, explanation of violation, place of 

occurrence, and name/address of police dept or court.

19. Have you been convicted by a military court-martial in the 

past 7 years? 

YES NO If yes, provide in Section 21 the date, explanation of violation, place of 

occurrence, and name/address of military authority or court. 

20. Are you now under charges for any violation of law? YES NO If yes, provide in Section 21 the date, explanation of violation, place of 

occurrence, and name/address of police dept or court.

21. REMARKS (Use this space for continuation of answers. List the item number being explained.)

APPLICANT CERTIFICATION

I certify that, to the best of my knowledge and belief, all of the information on and attached to this application is true, correct, complete and made in good 

faith. I understand that false or fraudulent information on or attached to this application may be grounds for not hiring me, or firing me after I begin work, 

and may be punishable by fine or imprisonment. I understand that any information I give may be investigated.

SIGNATURE DATE SIGNED