OPM Form 1655A with track changes

United States Office of Personnel Management

Form Approved:
OMB No. 3206-0248

Geographic Preference Statement for
Senior Administrative Law Judge Applicant
Instructions: Type or print clearly in black or blue ink. In the boxes below, indicate with an "X" each location where you would be
available to serve as a Senior Administrative Law Judge (SALJ). You may show availability for any locations listed. You will be
considered only for positions where you have indicated your availability. Submit form to: Administrative Law Judge Program
Office, U.S. Office of Personnel Management, 1900 E Street, NW, Washington, DC 20415.
Name (Last, First, MI)

Address (Street, City, State, Zip Code)

Indiana

Oregon

Iowa

Pennsylvania

Kansas

Puerto Rico

Kentucky

Rhode Island

Louisiana

South Carolina

Maine

South Dakota

Maryland

Tennessee

(Rockville, MD; Alexandria, VA;

Massachusetts

Texas

Arlington, VA; Falls Church, VA;

Michigan

Utah

Minnesota

Vermont

Mississippi

Virginia

Missouri

Washington

Montana

West Virginia

Nebraska

Wisconsin

Nevada

Wyoming

All Locations
Check this box only
if you are interested in
all locations.
All Locations

Washington, DC,
Metro Area
Washington, DC, Metro Area

Washington, DC)

Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
5 U.S.C. § 3323(b)
5 CFR 930.201 et seq

New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Page 1

OPM Form 1655-A
May 20184

United States Office of Personnel Management

Region 1 - Boston

Form Approved:
OMB No. 3206-0248

Region 2 - New York

Region 3 - Philadelphia

All Region 1

All Region 2

All Region 3

Hartford, CT

Cherry Hill, NJ

Dover, DE

New Haven, CT

Jersey City, NJ

Baltimore, MD

Boston, MA

Newark, NJ

Elkins Park, MD

Lawrence, MA

Pennsauken, NJ

Harrisburg, PA

Lowell, MA

Albany, NY

Johnstown, PA

Springfield, MA

Bronx, NY

Philadelphia, PA

Portland, ME

Brooklyn, NY

Pittsburgh, PA

Manchester, NH

Buffalo, NY

Seven Fields, PA

Providence, RI

Jericho, NY

Wilkes-Barre, PA

Other

New York, NY

Charlottesville, VA

Queens, NY

Newport News, VA

Rochester, NY

Norfolk, VA

Syracuse, NY

Richmond, VA

White Plains, NY

Roanoke, VA

Mayaguez, PR

Charleston, WV

Ponce, PR

Huntington, WV

San Juan, PR

Morgantown, WV

Other

Other

5 U.S.C. § 3323(b)
5 CFR 930.201 et seq

Page 2

OPM Form 1655-A
May 20184

United States Office of Personnel Management

Form Approved:
OMB No. 3206-0248

Region 4 - Atlanta
Region 6 - Dallas

All Region 4

Memphis, TN

Birmingham, AL

Nashville, TN

All Region 6

Florence, AL

Other

Fort Smith, AR

Mobile, AL

Little Rock, AR
Region 5 - Chicago

Alexandria, LA

Fort Lauderdale, FL

All Region 5

Covington, LA

Fort Myers, FL

Chicago, IL

Metairie, LA

Jacksonville, FL

Evanston, IL

New Orleans, LA

Miami, FL

Oakbrook, IL

Shreveport, LA

Orlando, FL

Orland Park, IL

Albuquerque, NM

St. Petersburg, FL

Peoria, IL

McAlester, OK

Tallahassee, FL

Evansville, IN

Oklahoma City, OK

Tampa, FL

Fort Wayne, IN

Tulsa, OK

Atlanta, GA

Indianapolis, IN

Arlington, TX

Augusta, GA

Valparaiso, IN

Dallas, TX

Covington, GA

Detroit, MI

Fort Worth, TX

Macon, GA

Flint, MI

Galveston, TX

Savannah, GA

Grand Rapids, MI

Harlingen, TX

Lexington, KY

Lansing, MI

Houston, TX

Louisville, KY

Livonia, MI

San Antonio, TX

MIddlesboro, KY

Mount Pleasant, MI

Other

Paducah, KY

Oak Park, MI

Hattiesburg, MS

Bloomington, MN

Jackson, MS

Minneapolis, MN

All Region 7

Tupelo, MS

Akron, OH

West Des Moines, IA

Charlotte, NC

Cincinnati, OH

Topeka, KS

Fayetteville, NC

Cleveland, OH

Wichita, KS

Greensboro, NC

Columbus, OH

Columbia, MO

Raleigh, NC

Dayton, OH

Creve Couer, MO

Charleston, SC

Toledo, OH

Kansas City, MO

Columbia, SC

Madison, WI

St. Louis, MO

Greenville, SC

Milwaukee, WI

Springfield, MO

Chattanooga, TN

Other

Omaha, NE

Montgomery, AL

Franklin, TN

Region 7 - Kansas City

Other

Kingsport, TN
Knoxville, TN

5 U.S.C. § 3323(b)
5 CFR 930.201 et seq

Page 3

OPM Form 1655-A
May 20184

United States Office of Personnel Management

Region 8 - Denver

Form Approved:
OMB No. 3206-0248
Tucson, AZ

Stockton, CA

All Region 8

Alameda, CA

Honolulu, HI

Colorado Springs, CO

Fresno, CA

Las Vegas, NV

Denver, CO

Irvine, CA

Reno, NV

Billings, MT

Long Beach, CA

Other

Fargo, ND

Los Angeles, CA

Aberdeen, SD

Moreno Valley, CA

Rapid City, SD

Norwalk, CA

All Region 10

Sioux Falls, SD

Oakland, CA

Anchorage, AK

Salt Lake City, UT

Orange, CA

Boise, ID

Casper, WY

Pasadena, CA

Eugene, OR

Other

Sacramento, CA

Portland, OR

San Bernardino, CA

Auburn, WA

San Diego, CA

Seattle, WA

All Region 9

San Francisco, CA

Spokane, WA

Phoenix, AZ

San Rafael, CA

Tacoma, WA

San Jose, CA

Santa Barbara, CA

Other

Region 9 - San Francisco

Region 10 - Seattle

Privacy Act Statement
The information on this form is collected pursuant to 5 U.S.C. § 3323(b) and 5 CFR 930.201 et seq. This completed form allows
us to refer your application to Federal agencies that have SALJ positions where you may want to work. In addition, this record
may be used to develop statistics and studies concerning our SALJ Program. Supplying this information is voluntary, but if you do
not provide it you may lose job opportunities because we may not be able to properly refer your application.

Public Burden Statement
We estimate the public reporting burden for this collection will vary from 15 to 25 minutes with an average of 10 minutes per
response, including time for reviewing instructions, searching existing data sources, gathering data, and completing and
reviewing the 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 (OPM), Administrative Law Judge
Program Office, ALJ Program Manager, Washington, DC 20415-7900. The OMB number, 3206-0248, is currently valid. OPM
may not collect this information and you are not required to respond, unless this number is displayed. Do not send completed
application forms to this address.

Reasonable Accommodation
Federal agencies must provide reasonable accommodation to applicants with disabilities where appropriate. Applicants requiring
reasonable accommodation for any part of the hiring process should contact the appointing agency directly. Determinations on
requests for reasonable accommodation will be made on a case-by-case basis.

THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
Signature

5 U.S.C. § 3323(b)
5 CFR 930.201 et seq

Date

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OPM Form 1655-A
May 20184