Free appoint00.PDF - Oklahoma

APPLICATION FOR JUDICIAL BRANCH FEDERAL EMPLOYMENT - AO 78
If you need additional space, continue under "Remarks" listing item number 1. Name Last, First, Middle Initial 4. Present Address 2. Phone Number 3. Social Security Number 5. Place of Birth

6. Other names used for employment purposes

7. Date of Birth

City State Foreign Country

8. 9.

Are you a U.S. Citizen? G yes G no - Give the Country of your citizenship a. Were you ever a federal civilian employee? G yes G no - If yes, highest civilian grade/salary: grade/salary b. Are you receiving a federal annuity or severance payment? G yes G no Do you have any relatives who are Judges, Officers or employees of the United States Courts? If so give their names, positions, and relationships to you.
none

10.

11. 12.

Have you ever been discharged from a position or asked to resign under the threat of discharge? 9 yes 9 no If yes, explain under Remarks. Have you ever been convicted? 9 yes 9 no (You may omit: (1) offenses committed before your 18 th birthday and adjudicated under a 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.

13.

EDUCATION a. Do you have a high school diploma or G.E.D? 9 yes 9 no

If yes, Date of Completion

b.

Name and location of colleges or universities attended (including law schools)

Dates Attended

Credit Hours Quarter Semester

Degree

Date Received

Grade Point Average and/or Scholastic Standing

Chief Undergraduate Subjects

Credit Hours
Quarter Semester

Chief Graduate Subjects

Credit Hours
Quarter Semester

c. Specify special skills, accomplishments, awards, honors, fraternities, sororities & societies.

G None

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

14. MILITARY SERVICE a. Have you ever served on active duty with the military? G yes G no If yes, attach a copy of DD 214, Notice of Separation G yes G no

b. Are you retired from military service? APPLICANTS FOR LEGAL POSITIONS a. Are you admitted to the Bar? G yes Is your Bar membership G Active b. Did you attend a bar review course?

G no If yes, list the bar(s) to which admitted and dates of admission: G Inactive G yes G no If yes, Dates Attended (month, day, year): from

to

AO 78 (4/98)

WORK EXPERIENCE Including experience while in military service.
(Start with your present position and work back 10 years. Use additional page if necessary.)

May we ask your present employer about your character, qualifications, and work record? A "NO" will not affect our review of your qualifications. If you answer "NO"and we need to contact your present employer before we can offer you a job, we will contact you first. 9 Yes 9 No

A
Dates of Employment (month, day, year) From Salary or Earnings Starting $ Final $ Per Per To Classification Grade/Level (If in federal service) Place of Employment City State or Country Name and Title of Immediate Supervisor Kind of Business or Organization Number of hours worked per week: Exact Title of Your Position

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

Business Telephone: Reason for Leaving Description of Work

Area Code

Number

B
Dates of Employment (month, day, year) From Salary or Earnings Starting $ Final $ Per Per To Classification Grade/Level Place of Employment City State or Country Name and Title of Immediate Supervisor Kind of Business or Organization Number of hours worked per week: Exact Title of Your Position

(If in federal service)

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

Business Telephone: Reason for Leaving Description of Work

Area Code

Number

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

CONTINUATION SHEET-AO-78

C
Dates of Employment (month, day, year) From Salary or Earnings Starting $ Final $ Per Per To Classification Grade/Level (If in federal service) Place of Employment City State or Country Name and Title of Immediate Supervisor Kind of Business or Organization Number of hours worked per week: Exact Title of Your Position

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

Business Telephone: Reason for Leaving Description of Work

Area Code

Number

D
Dates of Employment (month, day, year) From Salary or Earnings Starting $ Final $ Per Per To Classification Grade/Level Place of Employment City State or Country Name and Title of Immediate Supervisor Kind of Business or Organization Number of hours worked per week: Exact Title of Your Position

(If in federal service)

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

Business Telephone: Reason for Leaving Description of Work

Area Code

Number

General Instructions

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"This information is being solicited pursuant to Public Law 93-579, the Privacy Act of 1974, from individuals completing federal records and forms requesting personal information." "Complete section C of this form and submit it with your application. The form will be separated from your application and kept confidential. This information is being gathered to evaluate the effectiveness of the recruitment process. It will be used only for statistical and analytical purposes."

2a

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AO 78A Part C - GENERAL INSTRUCTIONS

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The top portion of the form should be submitted when a new appointment is made. It may also be submitted if there is any change in the data previously reported, either to correct an
error or to accommodate changed circumstances.
The bottom portion of the form, containing information as to applicants and interviewees, is for the court's own use and should be retained in the court, either by the appointing officer or by the E.E.O. Coordinator.

Items 7-13 need not be completed on the top portion of the form as this information will generally be reflected in other appointment papers. Handicap codes may be determined by consulting the attached sheet. Race/National Origin codes are as follows: (1) White; (2) Black; (3) Hispanic; (4) Asian; (5) American Indian.

(Rev

September 1993)