Form Approval
                                                        OMB No. 3206-0182

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 Management                                       NSN 7540-01-368-7775                       Optional Form 306
5 u.s.c. 1302, 3301, 3304, 3328 & 8716                                                                                                                               Revised January 2001
                                                                                                                                                                 Previous editions obsolete and unusable

GENERAL INFORMATION 
1. FULL NAME {First, middle, last) 						2. SOCIAL SECURITY NUMBER
                                                                                                                   |                                                                            |
3  PLACE OF BIRTH (Include city and state or country) 				4.DATE OF BIRTH (MM/DD/YYYY) 

                                                                                                                   |                                                                            |
5. OTHER NAMES EVER USED (For example, maiden name, nickname, etc) 		6. PHONE NUMBERS (Include area codes) 

                                                                                                                   | Day:                              Night:                             | 

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. 
7a. Are you a male born after December 31, 1959?               YES                NO    If “NO” skip 7b and7c.  If “YES”  go to 7b. 
7b. Have you registered with the Selective Service System?              YES                NO   If ”NO” go to 7c. 
7c.  If “NO”, describe your reason(s) in item #16. 
Military Service 
8. Have you ever served in the United States military?                YES Provide information below                     NO
    If you answered “YES”, list the branch, dates, and type of discharge for all active duty. 
   If your only active duty was training in the Reserves or National Guard, answer “NO”.
                
                    Branch	                   From
              MM/DD/YYYY	             To
     MM/DD/YYYY	
          Type of Discharge	

				

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?                            YES              NO
       (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. 
                                                                                                                                                                                               |
10.  Have you been convicted by a military court-martial in the past 10 years? (If no military service, answer "NO. ") If                      YES              NO
       "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. 
                                                                                                                                                                                               |
11.  Are you now under charges for any violation of law? If "YES, " use item 16 to provide the date, explanation of  the                                            YES              NO
        violation, place of occurrence, and the name and address of the police department or court involved. 
                                                                                                                                                                                               |
12.   During the last 5 years, have you been fired from any job for any reason, did you quit after being told that you                           YES              NO
        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              NO
      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 Management                                       NSN 7540-01-368-7775                             Optional Form 306
5 u.s.c. 1302, 3301, 3304, 3328 & 8716                                                                                                                                          Revised January 2001
                                                                                                                                                                             Previous editions obsolete and unusable

Additional Questions 
14. Do any of your relatives work for the agency or government organization to which you are submitting this form?                       YES              NO
      (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,                             YES              NO
      Federal civilian, or District of Columbia Government service? 
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 for purposes 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 individuals 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:                                                                                      | Date:                                  |        Appointing Officer: 
Below, enter Date of Appointment 
or conversion  (MM/DD/YYYY)
 
17b.   Appointee’s Signature:                                                                                    | Date:                                  |             

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. 

18a. When did you leave your last Federal job?            DATE:                                   |   (MM/DD/YYYY)

18b. When you worked for the Federal Government the last time, did you waive Basic Life Insurance or                YES              NO      Do Not Know
        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               YES              NO      Do Not Know
        "NO," use item 16 to identify the type(s) of insurance for which waivers were not canceled. 

u.s. Office of Personnel Management                                       NSN 7540-01-368-7775                             Optional Form 306
5 u.s.c. 1302, 3301, 3304, 3328 & 8716                                                                                                                                          Revised January 2001
                                                                                                                                                                             Previous editions obsolete and unusable