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Free AO 078 - Application for Judical Branch Federal Employment - Federal



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Excerpt: OAO 78 (6/03) 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/St
OAO 78
(6/03)

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

GENERAL
8. Are you a U.S. Citizen? YES

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NO

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-- 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?

' ' '

NO NO NO

' ' '

-- For highest civilian grade give: grade

/
step

Former agency contact/tel:

10. Do you have any relatives that are Judges, Officers or employees of the United States Courts? If so, give their names, positions, and relationships to you. NO YES

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'

11. Have you ever been discharged from a position or asked to resign under the threat of discharge? Remarks at the end of this form.

YES

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NO

'

If yes, explain under

NO (You may omit: (1) offenses committed before your 18th birthday and adjudicated under a 12. Have you ever been convicted? YES juvenile offender law; (2) offenses adjudicated under a youth offender law; (3) offenses as to which the record has been expunged; (4) minor traffic violations for which you paid a fine of $100 or less) If yes, explain under Remarks at the end of this form.

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'

EDUCATION
13. a. Do you have a high school diploma or G.E.D. equivalent? b. Name and location of colleges or universities attended (including law schools) YES Dates Attended

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NO

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If yes, Date of Completion Degree Date Received Grade Point Average and/or scholastic standing

Number of Quarter Semester

Chief Undergraduate Subjects

Credit Hours Quarter Semester

Chief Graduate Subjects

Credit Hours Quarter Semester

c. d. e. f.

Special skills, accomplishments, awards, honors, fraternities, sororities & societies (Specify) What was your scholastic standing in college/law school (Specify)? UPPER

YES

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NO

'

'

UPPER a YES

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UPPER NO

'

Were you a member of an editorial board of law review or a moot court participant?

'

Other schools or training such as trade, vocational, Armed Forces, or business. Give for each: Name and location of school, dates attended, subject studied, certificates, and any other pertinent data.

MILITARY SERVICE
14. a. Have you ever served on active duty with the military? b. Are you retired from military service? APPLICANTS FOR LEGAL POSITIONS 15. a. Are you admitted to the Bar? YES YES YES

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NO

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If yes, attach DD 214 member-4 copy, Notice of Separation.

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NO

NO

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' '
YES

'

If yes, list the Bar(s) to which admitted and date(s) of admission:

Is your Bar membership b. Did you attend a Bar review course?

ACTIVE

INACTIVE

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NO

' '

List type of course: Dates Attending: From: mm/dd/yyyy To mm/dd/yyyy

O AO 78 Page 2 (6/03)

WORK EXPERIENCE
A
From: Salary or Earnings Starting $ Final $

Include experience while in military service. (Start with your present position and work back 10 years. Use additional page if necessary.)
Number of hours worked per week: Grade/Step (If in federal Service) Exact Title of Your Position Place of Employment City State

Dates of Employment (month, day, year) To Per Per

Kind of Business or Organization

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

Name and Title of Immediate Supervisor

Business Telephone: (Area Code and Phone Number) Reason for Leaving Description of Work

Number of Employees Supervised

B
Dates of Employment (month, day, year) From: Salary or Earnings Starting $ Final $ To Per Per Grade/Step (If in federal Service) Place of Employment City State Name and Address of Employer (firm, organization, etc.) Name and Title of Immediate Supervisor Kind of Business or Organization Number of hours worked per week: Exact Title of Your Position

Business Telephone: (Area Code and Phone Number) Reason for Leaving Description of Work

Number of Employees Supervised

REMARKS: (Use this space for continuation of answers. List the number of items being continued.)

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

O AO 78 Page 3 (6/03)

WORK EXPERIENCE CONTINUATION SHEET - AO 78
C
Dates of Employment (month, day, year) From: Salary or Earnings Starting $ Final $ To Per Per State Name and Address of Employer (firm, organization, etc.) Name and Title of Immediate Supervisor Grade/Step (If in federal Service) Place of Employment City Kind of Business or Organization Number of hours worked per week: Exact Title of Your Position

Business Telephone: (Area Code and Phone Number) Reason for Leaving Description of Work

Number of Employees Supervised

D
Dates of Employment (month, day, year) From: Salary or Earnings Starting $ Final $ To Per Per Grade/Step (If in federal Service) Place of Employment City State Name and Address of Employer (firm, organization, etc.) Name and Title of Immediate Supervisor Kind of Business or Organization Number of hours worked per week: Exact Title of Your Position

Business Telephone: (Area Code and Phone Number) Reason for Leaving Description of Work

Number of Employees Supervised

REMARKS: (Use this space for continuation of answers. List the number of items being continued.)

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

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File Size: 236.0 kB
Pages: 3
Date: July 31, 2008
File Format: PDF
State: Federal
Category: Court Forms - Federal
Author: US Courts
Word Count: 1,051 Words, 6,374 Characters
Page Size: Letter (8 1/2" x 11")
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http://www.uscourts.gov/forms/AO078.pdf