Ofo306

PRIVACY ACT AND PUBLIC BURDEN STATEMENT
The Office of Personnel Management is authorized to request
this information under sections 1302, 3301, 3304, and 8716 of
title 5 of the U.S. Code. Section 1104 of title 5 allows the Office
of Personnel Management to delegate personnel management
functions to other Federal agencies. If neces- sary, 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.
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 Reports and Forms Management Officer, U.S.
Office of Personnel Management, 1900 E Street, N.W.,
Washington, D.C. 20415.

Optional Form 306 (EG)
September 1994
U.S. Office of Personnel
Management

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 proceeding 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
representing 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 recognition 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, the
Federal Acquisitions Institute, and Congressional offices in
connection with their official functions; prospective
non-Federal employers concerning tenure of employ- ment,
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
con- cerning information issued to the employee about
fitness-for-duty or agency-filed disability retirement
procedures.

Declaration for Federal Employment

Form Approved:
O.M.B. No. 3206-0182

GENERAL INFORMATION
1 FULL NAME

2 SOCIAL SECURITY NUMBER

3 PLACE OF BIRTH (Include City and State or Country)

4 DATE OF BIRTH (MM/DD/YY)

5 OTHER NAMES EVER USED (For example, maiden name, nickname, etc.)

6 PHONE NUMBERS (Include Area Codes)
DAY
NIGHT

MILITARY SERVICE
7 Have you served in the United States Military Service?
Reserves or National Guard, answer "NO".
If you answered "YES", list
the branch, dates
(MM/DD/YY), and type of
discharge for all active duty
military service.

BRANCH

Yes

No

If your only active duty was training in the
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
FROM

TO

TYPE OF DISCHARGE

BACKGROUND INFORMATION
For all questions, provide all additional requested information under item 15 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 8, 9, and 10, 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 whose record was expunged under Federal or State law.

8

During the last 10 years, have you been convicted, been imprisoned, been on probation, or been on parole?
(Includes felonies, firearms or explosives violations, misdemeanors, and all other offenses.)
If "Yes", use item 15 to provide the date, explanation of the violation, place of occurrence, and the name and
address of the police department or court involved. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9

Have you been convicted by a military court-martial in the past 10 years? (If no military service, answer
"NO".) If "Yes", use item 15 to provide the date, explanation of the violation, place of occurrence, and the
name and address of the military authority or court involved. . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

Yes

No

10 Are you now under charges for any violation of law? If "Yes", use item 15 to provide the date, explanation of
the violation, place of occurrence, and the name and address of the police department or court involved. . .

11 During the last 5 years, were you 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? If "Yes", use item 15 to provide
the date, an explanation of the problem and reason for leaving, and the employer’s name and address. . . . .

12 Are you delinquent on any Federal debt?

(Includes 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 such as student and home mortgage loans.) If "Yes", use item 15 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. .

ADDITIONAL QUESTIONS
13 Do any of your relatives work for the agency or organization to which you are submitting this form?

(Includes
father, mother, husband, wife, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, fatherin-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 15 to provide the
name, relationship, and the Department, Agency, or Branch of the Armed Forces for which your relative works.

14 Do you receive, or have you ever applied for, retirement pay, pension, or other pay based on military, Federal
civilian, or District of Columbia Government service? . . . . . . . . . . . . . . . . . . . . . . . . . . .
Designed using Perform Pro, WHS/DIOR, Jan 95

CONTINUATION SPACE/AGENCY OPTIONAL QUESTIONS
15 Provide details requested in items 8 through 13 and 17c in the continuation 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 QUESTION
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, complete item 16/16a.
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, complete item 16/16b and answer item 17.

16 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 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 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.

17

16a

Applicant’s Signature
(Sign in ink)

16b

Appointee’s Signature
(Sign in ink)

Date

Date

APPOINTING OFFICER: Enter Date
of Appointment or Conversion

Appointee Only (Respond only 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.
Date (MM/DD/YY)

17a

When did you leave your last Federal job? . . . . . . . . . . . . . . . . . . . . . .

17b

When you worked for the Federal Government last time, did you waive Basic Life
Insurance or any type of optional life insurance? . . . . . . . . . . . . . . . . . . .

Yes

17c

No

Don’t Know

If you answered "Yes" to item 17b, did you later cancel the waiver(s)? If your answer
to item17c is "No," use item 15 to identify the type(s) of insurance for which waivers
were not cancelled. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Optional Form 306 (Back)
Optional Form 306
U.S. Office of Personnel
Management

September 1994

Declaration for Federal Employment

Form Approved:
O.M.B. No. 3206-0182

INSTRUCTIONS
The information collected on this form is used to determine your
acceptability for Federal 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, 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 before
you are appointed.

any other information requested, we cannot process your application.
Incomplete addresses and ZIP Codes may also slow processing.

Your Social Security Number is needed to keep our records accurate,
because people may have the same name and birthdate. Executive Order
9397 also asks Federal agencies to use this number to help identify
individuals in agency records. Giving us your SSN or other information
is voluntary. However, if you do not give us your SSN or

Either type your responses to this form or print clearly in dark ink. If
you need additional space, attach letter-size sheets (8.5" X 11"),
including your name, Social Security Number, and item number on
each sheet. It is recommended that you keep a photocopy of your
completed form for your records.

You must answer all questions truthfully and completely. 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 fine or imprisonment (U.S. Code,
title 18, section 1001.)