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AO 078, Application for Employment

If you wish to apply for employment at a legal position, you have to use this application form. Complete the form and submit it along with any required information in order to be considered for employment.

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AO 78 (10/09)	
F	EDERAL 	JUDICIAL 	B	RANCH	
APPLICATION FOR EMPLOYMENT
If you need additional space, continue under “Remarks” listing item number
1.  Name  (Last, First, Middle Initial) 2.  Phone Number
3.  Present Address  (Street, City, State, Zip)
4.  Email Address
5.  Other Names Previously Used for Employment Purposes 6.  Date of Birth  (complete only for law enforcement positions)	
GENERAL	
7.  Are you a U.S. Citizen?	’	YES	’	NO If no, give the Country of your citizenship
8.  a.  Were you ever a federal civilian employee?	
’	YES	’	NO If yes, give highest civilian grade: //
Pay Plan Grade Step
      b.  Are you receiving a federal civilian annuity payment?	
’	YES	’	NO
      c.  Are you receiving federal severance pay?	
’	YES	’	NO If yes, give former agency contact/telephone:
      d.  Have you received a federal separation incentive payment	
’	YES	’	NO If yes, state mo/yr received and former agency contact/telephone:
in the past 5 years? 
9.  Do you have any relatives who are Judges, Officers or 	
’	YES	’	NO If yes, give their names, positions, and relationships to you.
employees of the United States Courts?
10.  Have you ever served on active duty with the military?	
’	YES	’	NO (If selected, you will need to provide your DD-214 (copy 4), Certificate of
Release or Discharge from Active Duty, so that your service may be
verified and credited) 	
BACKGROUND INFORMATION	
For questions 11, 12, and 13, your answer
s 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 16	th birthday, (3) any violation of law committed before your 18	th birthday if finally decided in juve nile court or under a Youth Offender
law, (4) any conviction set aside under the Federal Youth Correcti ons Act or similar state law, and (5) any conviction for which the record was expunged under Federal or state
law.
11.  During the last 10 years, have you been convicted, imprisoned,
on probation, or on parole?  (Include felonies, firearms or  explosives
violations, misdemeanors, and all other offenses) 	
’	YES	’	NO If yes, provide in Section 19 the da te, explanation of violation, place of
occurrence, and name/address of police dept or court.
12.  Have you been convicted by a military court-martial in the past
10 years? 	
’	YES	’	NO If yes, provide in Section 19 the da te, explanation of violation, place of
occurrence, and name/address of  military authority or court. 
13.  Are you now under charges for any violation of law? 	
’	YES	’	NO If yes, provide in Section 19 the da te, explanation of violation, place of
occurrence, and name/address of police dept or court.
14.  During the last 10 years, have you been fired from any job for
any reason, did you quit after bei ng 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 or any other Federal agency?	
’	YES	’	NO If yes, provide in Section 19 the da te, explanation of problem, reason for
leaving, and employer’s name/address.
15.  Are you delinquent on any Federal debt?   (Include
delinquencies arising from Fede ral taxes, loans, overpayment of
benefits, and other debts to the U.S.  Government, plus defaults of
Federally guaranteed or insured  loans (e.g., student loan, home
mortgage loan)).	
’	YES	’	NO If yes, provide in Section 19 the type, length, and amount of delinquency/default, and step s being taken to correct the error/repay the debt.	
EDUCATION	
16.   a.  Do you have a high sc hool diploma or G.E.D. equivalent?	’	YES	’	NO If yes, Date of Completion

Page 2 of  5	
        b.  Name and location of colleges or universities
             attended (including law schools) Dates AttendedCredit Hours
Degree Date Received Grade Point
Average and/or
scholastic standing
Quarter Semester
16.  c.  Other schools or training attended  (list name/location of school, dates attended, subject studied, certificates received, and other pertinent data):	
JOB RELATED SKILLS, AWARDS, SPECIAL ACCOMPLISHMENTS	
17.  List any skills (e.g., language, computer, keyboarding speed ), honors, awards, or special accomplishments (e.g., membershi ps in professional/honor societies, leadership
activities, performance awards) that you believe are relevant to your ability to perform the job: 	
APPLICANTS FOR LEGAL POSITIONS	
18.  a.  Are you admitted to the Bar?	’	YES	’	NO If yes, list the Bar(s) to  which admitted and date(s) of admission.  If no, skip to 
18b.
            Is your Bar membership	
’ ACTIVE ’	INACTIVE
       b.  What was your scholastic standing in law school?	
’	UPPER ½	’	UPPER  a 	’	UPPER ¼
       c.  Were you a member of an editorial board of law review or a 	
’	YES	’ No	
moot court participant? 	
19.  REMARKS  (Use this space for continuation of answe rs.  List the item number being explained.)

Page 3 of  5	
WORK EXPERIENCE
(Start with your present position and work back 10 years.  In clude any military service. Use additional page if necessary.)
A	
Dates of Employment  (mm/dd/yyyy) Number of hours
worked per week: Exact Title of Your Position
From: To:
Salary or Earnings Pay Plan/Grade
(If in federal Service) Place of Employment
Starting $ Per City
Final $ Per State
Name and Address of Employer   (firm, organization, etc.) Name and Title of Immediate Supervisor
Business Telephone:  (Area Code and Phone Number)
Reason for Leaving
Description of Work
B
Dates of Employment  (mm/dd/yyyy) Number of hours
worked per week: Exact Title of Your Position
From: To:
Salary or Earnings Pay Plan/Grade
(If in federal Service) Place of Employment
Starting $ Per City
Final $ Per State
Name and Address of Employer   (firm, organization, etc.) Name and Title of Immediate Supervisor
Business Telephone:  (Area Code and Phone Number)
Reason for Leaving
Description of Work

Page 4 of  5	
C
Dates of Employment (mm/dd/yyyy) Number of hours
worked per week: Exact Title of Your Position
From: To:
Salary or Earnings Pay Plan/Grade
(If in federal Service) Place of Employment
Starting $ Per City
Final $ Per State
Name and Address of Employer   (firm, organization, etc.) Name and Title of Immediate Supervisor
Business Telephone:  (Area Code and Phone Number)
Reason for Leaving
Description of Work
D
Dates of Employment  (mm/dd/yyyy) Number of hours
worked per week: Exact Title of Your Position
From: To:
Salary or Earnings Pay Plan/Grade
(If in federal Service) Place of Employment
Starting $ Per City
Final $ Per State
Name and Address of Employer   (firm, organization, etc.) Name and Title of Immediate Supervisor
Business Telephone:  (Area Code and Phone Number)
Reason for Leaving
Description of Work

Page 5 of  5	
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 a ttached 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 unders tand that any information I give may be investigated.
SIGNATURE DATE SIGNED
Next: AO 436, Audio Recording Order Previous: AO 246A, Order of Discharge and Dismissal Under 18 U. S. C. § 3607(a)
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