APPLICATION FOR JUDICIAL BRANCH FEDERAL EMPLOYMENT
3. Social Security Number
If You Need Additional Space, Continue Under "Remarks" Listing Item Number Instructions - AO78 1. Name (Last, First, Middle Initial) Mr Miss. Mrs. Ms. 1 a. Gender 2. Phone Number M F
4. Present Address (Street, City, State, Zip)
5. Place of Birth City/State Foreign Country
6. Other Names Previously Used for Employment Purposes
7. Date of Birth
8. Are you a U.S. Citizen? YES
-- If not, give the Country of your citizenship YES YES YES
9. a. Were you ever a federal civilian employee? b. Are you receiving a federal annuity payment? c. Are you receiving federal severance pay?
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NO NO NO
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-- For highest civilian grade give: grade
Former agency contact/tel:
10. Do you have any relatives that are Judges, Of