Form DD Form 2945 DD Form 2945 Post Government Employment Advice Opinion Request

REPORT CONTROL
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DD-GC(AR)2412

POST-GOVERNMENT EMPLOYMENT ADVICE OPINION REQUEST
(Read Privacy Act Statement on the last page before completing form.)

OMB No. 0704-0467
OMB approval expires

The public reporting burden for this collection of information is estimated to average 90 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center
Drive, Alexandria, VA 22350-3100 (0704-0467). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a
collection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION.

SECTION I - CONTACT INFORMATION
1. DOD AGENCY YOU WORKED OR ARE WORKING
FOR (e.g., Army, Navy, DLA, OSD, JCS, etc.)

2.a. FIRST NAME

3. HOW DO YOU WANT TO RECEIVE YOUR OPINION (X one)

b. MIDDLE
INITIAL
BY E-MAIL

4. MAILING ADDRESS
a. STREET 1

c. LAST NAME

BY POSTAL MAIL

b. STREET 2

c. CITY

d. STATE

e. ZIP/POSTAL CODE

5. TELEPHONE NUMBER (Include Area Code). a. PRIMARY

b. ALTERNATE

6. PERSONAL E-MAIL ADDRESS. a. PRIMARY

b. ALTERNATE

f. COUNTRY

SECTION II - SERVICE INFORMATION
7. EMPLOYEE STATUS AT TIME OF SEPARATION
a. X one:

MILITARY

b. RANK/PAY PLAN AND GRADE

CAREER CIVILIAN:

OTHER (Specify as Non Career SES,
schedule C, IPA, HQE, SGE)
c. IF A POLITICAL APPOINTEE, HAVE YOU MADE OTHER ETHICS COMMITMENTS? (If yes, provide detail: did you receive a waiver, or do you anticipate
work as a lobbyist)

D R A F T

8. DOD ORGANIZATION

9. DOD SUPERVISOR'S NAME

10. REASON FOR SEPARATION
RETIREMENT

OTHER (Specify)

RESIGNATION

11. SEPARATION/RETIREMENT DATE (MM/DD/YYYY)
13. DO YOU PLAN TO WORK WHILE ON
TERMINAL/TRANSITION LEAVE?
NO

12. TERMINAL/TRANSITION LEAVE DATE (Enter date(s) inMM/DD/YYYY
format, respectively)

14. FOR CIVILIAN EMPLOYEES: DID YOU RETIRE
FROM THE U.S. ARMED FORCES?

YES

NO

YES

15. ARE YOU A RESERVIST?
NO

YES

SECTION III - PRIOR ETHICS INFORMATION
16. PRIOR ETHICS ADVICE
a. HAVE YOU RECEIVED ANY ETHICS ADVICE OR OPINION FROM ANOTHER GOVERNMENT ETHICS OFFICIAL CONCERNING YOUR
PROSPECTIVE EMPLOYMENT?
NO PRIOR ADVICE RECEIVED
YES, PRIOR ADVICE RECEIVED (Complete b.)
b. (1) ETHICS OFFICIAL'S NAME

(2) OFFICE

(3) TELEPHONE NUMBER

17. FINANCIAL DISCLOSURE
a. IN THE LAST 2 YEARS, HAVE YOU FILED A FINANCIAL DISCLOSURE REPORT?
NO

YES, OGE 450

YES, OGE 278 (If you file a OGE 278, you must file a termination report no later than 30 days after

separation.)

b. IF YES, POSITIONS FOR WHICH YOU FILED

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SECTION III - PRIOR ETHICS INFORMATION (Continued)
18. LICENSED ATTORNEY: PLEASE INDICATE IF YOU ARE A LICENSED ATTORNEY, EVEN IF YOU ARE NOT EMPLOYED AS AN
ATTORNEY BY DOD.
NO , I AM NOT A LICENSED ATTORNEY

YES, I AM A LICENSED ATTORNEY

SECTION IV - DOD POSITION INFORMATION
19. POSITIONS HELD AND MAJOR DUTIES: IN WHAT AGENCIES OR ORGANIZATIONS HAVE YOU SERVED DURING YOUR LAST 5 YEARS
OF DEPARTMENT OF DEFENSE SERVICE? For each position, describe your job or briefly describe your major duties during the last 5 years, focusing on
supervisory duties and official responsibility requirements relating to defense contracts,especially related to prospective employers, any aspect of the acquisition
process, such as requirements development, acting as program manager, deputy program manager or contracting officer, or otherwise involved in the contracting
process. Identify names of projects, program, contractors and subcontractors.)

a. CURRENT/MOST RECENT POSITION
(1) ORGANIZATION OR AGENCY

(2) JOB TITLE

(3) DESCRIPTION

(4) POSITION HELD:

D R A F T

FROM (MM/YYYY)
b. PRIOR POSITION 1
(1) ORGANIZATION OR AGENCY

TO (MM/YYYY)
(2) JOB TITLE

(3) DESCRIPTION

(4) POSITION HELD:
FROM (MM/YYYY)
c. PRIOR POSITION 2
(1) ORGANIZATION OR AGENCY

TO (MM/YYYY)
(2) JOB TITLE

(3) DESCRIPTION

(4) POSITION HELD:
FROM (MM/YYYY)

DD FORM 2945, 20120807 DRAFT

TO (MM/YYYY)
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SECTION IV - DOD POSITION INFORMATION (Continued)
20. HAVE YOU SERVED IN ANY OF THE FOLLOWING POSITIONS OR PERSONALLY TAKEN ONE OF THE FOLLOWING ACTIONS REGARDING
AN ACQUISITION OR CONTRACT IN EXCESS OF $10 MILLION?
b. A MEMBER OF A SOURCE SELECTION EVALUATION BOARD, OR A
a. PROCURING CONTRACTING OFFICER OR SOURCE
CHIEF OF A FINANCIAL OR TECHNICAL EVALUATION TEAM?
SELECTION AUTHORITY?
NO
YES
NO
YES
c. PROGRAM MANAGER, DEPUTY
PROGRAM MANAGER, OR
ADMINISTRATIVE CONTRACTING
OFFICER?
NO

e. ESTABLISHING
OVERHEAD
OR OTHER RATES?

d. AWARD OF A CONTRACT, SUBCONTRACT,
MODIFICATION, TASK ORDER OR
DELIVERY ORDER, OR PAYMENT OF A
CONTRACT CLAIM?

YES

NO

YES

NO

YES

f. APPROVAL OF A
CONTRACT PAYMENT
OR PAYMENTS?
NO

YES

g. IF YOU ANSWERED "YES" TO ANY OFTHESE QUESTIONS, IDENTIFY THE CONTRACT(S) IN WHICH YOU PERFORMED THAT FUNCTION
(List contract number(s), title(s) and date(s) of last action and summarize your duties/responsibilities related to that contract.)

D R A F T
21.a. DO YOU HOLD A POSITION IN THE EXECUTIVE SERVICE, SENIOR EXECUTIVE
SERVICE OR A GENERAL OR FLAG POSITION (Grade O7 and above - not frocked)?
NO
YES

b. DID YOU PARTICIPATE IN AN ACQUISITION WITH
A VALUE IN EXCESS OF $10 MILLION?
NO
YES

SECTION V - PROSPECTIVE EMPLOYER INFORMATION
22. CONFLICT OF INTEREST
a. HAVE YOU TAKEN ANY ACTION TO RESOLVE A POTENTIAL CONFLICT OF INTEREST RELATED TO SEEKING EMPLOYMENT EFFORTS,
INCLUDING ISSUING A WRITTEN DISQUALIFICATION, CHANGING JOBS, HAD YOUR DUTIES CHANGED, OR TAKEN ANY OTHER ACTION TO
RESOLVE A POTENTIAL CONFLICT OF INTEREST?
NO
YES
b. IF YES, PROVIDE DETAILS:

23. WITH WHOM ARE YOU SEEKING EMPLOYMENT?

24. WHAT ACTIONS HAVE YOU TAKEN CONCERNING YOUR FUTURE EMPLOYMENT (i.e., sent out resume, interview, filed disqualification, accepted a
position)?
25. DESCRIBE ANY OFFICIAL INVOLVEMENT WITH OR DUTIES YOU HAVE HAD RELATED TO PROSPECTIVE EMPLOYERS LISTED IN BLOCK
23.

26. FUTURE JOB TITLE
a. JOB TITLE

b. JOB DESCRIPTION (Include information on how this may relate to your Government duties.)

27. START DATE: WHEN DO YOU PLAN TO START YOUR NEW EMPLOYMENT? (MM/DD/YYYY)
I certify that the information provided on this form is true and accurate to the best of my knowledge.
29. SIGNATURE
28. PRINTED FULL NAME

DD FORM 2945, 20120807 DRAFT

30. DATE SIGNED

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31. ADDITIONAL COMMENTS

D R A F T

DD FORM 2945, 20120807 DRAFT

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Page 4 of 4 Pages

INSTRUCTIONS FOR COMPLETING DD FORM 2945
Please answer all questions as appropriate. Then print your full name,
sign and date the form.
SECTION I - CONTACT INFORMATION.
1. Please provide the Department of Defense Agency of your last
assignment. (Example: US Army, US Air Force, Defense Intelligence
Agency.) Do not abbreviate.

17. Financial Disclosure. X one. Mark No if you have not filed an
OGE 450 or OGE 278 report within the last two years. Mark Yes if
you have filed either an OGE 450 or OGE 278 financial disclosure
report within the last two years. If either the OGE 450 or OGE 278 is
selected, provide the position title you were assigned to when you
filed the report.
18. Licensed Attorney. X one. Self explanatory.

D R A F T

2. Enter your first name, middle initial and last name.

SECTION IV - DoD POSITION INFORMATION.

3. Contact preference. Mark (X) e-mail or postal mail to indicate your
preference on how to provide the written opinion to you.

19. Positions Held and Major Duties. Self explanatory. If more than
three, continue in block 31, "Additional Comments".

4. Enter your complete mailing address, including country if this
address is outside the United States.

20. Duties and Actions if Involved in a Contract in Excess of $10
Million.
a. X one. Self explanatory.
b. X one. Self explanatory.
c. X one. Self xplanatory.
d. X one. Self explanatory.
e. X one. Self explanatory.
f. X one. Self explanatory.
g. If Yes was answered to any of questions 20.a. - f., provide the
contract number(s), contract title(s), and date(s) you last acted on
those contracts and provide a summary of your duties and
responsibilities.

5. Provide a primary telephone number to include the area code or
country code if appropriate. Provide an alternate telephone number to
include the area code or country code if appropriate.
6. Provide a primary valid e-mail address. Provide an alternate e-mail
address if appropriate.
SECTION II - SERVICE INFORMATION.
7. Employee Status.
a. X Military, Civilian, or Other. If other, specify.
b. Provide military rank or civilian pay grade.
c. If a political appointee, provide details of any other ethics
commitments.
8. Provide the name of the last organization you were assigned to as a
member of DoD. Do not abbreviate.
9. Provide the name of your immediate supervisor of your last position
in DoD.
10. Reason for Separation. X one. Mark Retirement if you retired or
are retiring from DoD. Mark Resignation if you resigned or are
resigning from DoD. Mark Other if neither retirement nor resignation
applies.
11. Separation/Retirement Date. Enter date in MM/DD/YYYY format.
12. Terminal/Transition Leave Date(s). Enter date(s) in MM/DD/YYYY
format. Provide both dates if applicable.
13. Do you plan to work while on terminal/transition leave? X one.
14. U.S. Armed Forces retirement. X one. If your employee status is a
civilian and you previously retired from the U.S. Armed Forces before
becoming a civilian employee of DoD, X Yes. X No if you are a civilian
employee who did not previously retire from the U.S. Armed Forces.

21. Senior Executive Service, General or Flag Officer Position. X
one. Self explanatory.
SECTION V - PROSPECTIVE EMPLOYER INFORMATION.
22. Conflict of Interest. X one. If you have taken any action to
resolve a potential conflict of interest, including issuing a written
disqualification, changing jobs, had your duties changed, or taken
any other action to resolve a potential conflict of interest, mark Yes.
Provide a summary of the actions you took to resolve the conflict of
interest. If you have not taken any action to resolve a potential
conflict of interest, mark No.
23. Position Sought. Provide the name of the civilian company with
which you are seeking employment. Do not abbreviate.
24. Summarize the stage you are at regarding your efforts to
become employed with this company for a specific position. Actions
include submitting a resume, being interviewed, negotiating
compensation, etc.
25. Describe any official involvement or duties you have previously
had with the company listed in item 23.
26. Future Job Title. Provide the specific position/job title in which
you anticipate being employed. Provide specific duties and
responsibilities of the position. Include information on how this may
relate to your Government duties.

15. Are you a reservist? X Yes or No.
27. Start Date. Enter date in MM/DD/YYYY format.
SECTION III - PRIOR ETHICS INFORMATION.
28. - 30. Name, Signature and Date. Self explanatory.
16. Prior Ethics Advice. X one. Mark Yes if you received any ethics
advice (oral or written) from an attorney concerning employment with a
civilian company. If so, provide the name, officeor organization and
telephone number of the attorney. Mark No if you did not receive any
prior ethics advice concerning employment by a civilian company.

DD FORM 2945 INSTRUCTIONS, 20120807 DRAFT

30. Additional Comments. Provide any additional information about
your pending employment with a civilian employer that you want your
ethics attorney to know.

PRIVACY ACT STATEMENT

AUTHORITY: 41 U.S.C. 2104; 5 C.F.R. 2635.107, Joint Ethics Regulation.
PRINCIPAL PURPOSE(S): To enable ethics officials to render ethics advice to military and civilian employees leaving
Government service. When completed, records are covered by OGE/GOVT-1,
http://dpclo.defense.gov/privacy/SORNs/govt/OGEGOVT-1.html.
ROUTINE USE(S): To disclose the information furnished by the reporting official, in accordance with provisions of section 105
of the Ethics in Government Act of 1978, as amended, to any requesting person.
a. To disclose, in accordance with section 105 of the Ethics in Government Act, as amended, and subject to the limitations
conntained in section 208(d)(1) of title 18, U.S.C., any determination granting an exemption pursuant to 208(b)(1) or 208(b)(3) of
title 18, U.S.C., to any requesting person.
b. To disclose pertinent information to the appropriate Federal, State, or local agency responsible for investigating, prosecuting,
enforcing, or implementing a statute, rule, regulation, or order, where the disclosing agency becomes aware of an indication of
violation or potential violation of civil or criminal law or regulation.

D R A F T

c. To disclose information to another Federal agency, to a court, or a party in litigation before a court or in an administrative
proceeding being conducted by a Federal agency, either when the Government is a party to a judicial or administrative
proceeding or in order to comply with a subpoena issued by a judge of a court of competent jurisdiction.
d. To disclose information to any source when necessary to obtain information relevant to a conflict-of-interest investigation or
determination.
e. By the National Archives and Records Administration or the General Services Administration in records management
inspections conducted under authority of 44 U.S.C. 2904 and 2906.
f. To disclose information to the Office of Management and Budget at any stage in the legislative coordination and clearance
process in connection with private relief legislation as set forth in OMB Circular No. A-19.
g. To disclose information to the Department of Justice, or in a proceeding before a court, adjudicative body, or other
administrative body before which OGE is authorized to appear, when: OGE, or an employee of OGE in his or her official
capacity, or any employee of OGE in his or her individual capacity (where the Department of Justice or OGE has agreed to
represent the employee); or the United States (when OGE determines that litigation is likely to affect OGE), is a party to
litigation or has an interest in such litigation, and the use of such records by the Department of Justice or OGE is deemed by
OGE to be relevant and necessary to the litigation provided, however, that the disclosure is compatible with the purpose for
which such records were collected.
h. To disclose the public financial disclosure report and any accompanying documents to reviewing officials in a new office,
department or agency when an employee transfers or is detailed from a covered position in one office, department or agency to
a covered position in another office, department or agency.
i. To disclose information to a Member of Congress or a congressional office in response to an inquiry made on behalf of an
individual who is the subject of the record.
j. To disclose information to contractors, grantees, experts, consultants, detailees, and other non-Government employees
performing or working on a contract, service, or other assignment for the Federal Government, when necessary to accomplish
an agency function related to this system of records.
NOTE: When DoD is requested to furnish such records to the Director or other authorized officials of the Office of Government
Ethics (OGE), such a disclosure is to be considered as made to those officers and employees of the agency which co-maintains
the records who have a need for the records in the performance of their official duties in accordance with the Ethics in
Government Act of 1978, 5 U.S.C. app., and other ethics-related laws. Executive orders and regulations conferring pertinent
authority on OGE, pursuant to the provision of the Privacy Act at 5 U.S.C. 552a(b)(1).
The DoD "Blanket Routine Uses" found at http://dpclo.defense.gov/privacy/SORNs/blanket_routine_uses.html may apply to
these records. Any release under a blanket routine use will be compatible with the purpose of the collection.
DISCLOSURE: Voluntary; however, failure to fully disclose information requested may result in receipt of incomplete advice or
inability to provide written advice. This may result in a delay in being hired by a Department of Defense contractor or receipt of
compensation from such contractor. Failure to comply may also result in the imposition of administrative penalties in
accordance with 41 U.S.C. 2105(c).

DD FORM 2945 INSTRUCTIONS (BACK), 20120807 DRAFT