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AO 425 Pre-Employment Information

Before employment, the following HR form has to be completed and submitted in order to provide the required information for the hiring process.

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AO 425 (Rev. 11/92)   	Pre-Employment Information	
SECTION A:
1. Name (Last, First, Middle):                                                                        \
        ,                                                               \
         ,
Previously Used Name(s):
2. Social Security Number: 3. Date of Birth:
4. Requesting Agency Name and Address:  
5. Name of Person Requesting  Information: Phone Number:
SECTION B:
1. Currently employed Separated (Specify Date)
2. Agency Name and Location of Official  Personnel Folder (complete address):
3. Grade/Level Step/Rate Salary Pay Basis
4. If Salary Includes Coast of Living Adjustme nt (COLA), Indicate Base Salary and COLA
Base: COLA:
5. Service Computation Date (SCD)
6. Retirement Plan
If retirement code is C, E, 1, or 6:   Date First Covered
If retirement code is K or M:   Elected FERS Automatically covered Date First Covered
SECTION C—RETIREMENT DATA
1. MILITARY: A.  Branch of Service B.  Retired Rank
C.  Check One and  Specify Date:    Retired  Transferred to Fleet Reserve   (Date)
2. FEDERAL CIVILIAN: A.  Civilian Retirement Date B. Retirement System Paying Annuity
SECTION D—GRADE AND PAY DATA
1. Date Entered Current Grade and Step/Rate
2A. Date of Last Within-Grade Increase (WGI) 2B. If WGI Was Denied, Date of Denial
3A.  Highest Previous Grade/Step Held  3B.  Dates Held:   From: To: Salary:
4.  Was Salary  Based on Special Rate or Locality? 	
      Yes 
 	 No	
5A.  Is Applicant on Grade Retention? 	
      Yes         No	
5B.  Retained Grade/Step:  5C. Date Grade Retention Began
6.  Is Applicant on Pay  Retention? 
  Yes 
 
 No	
7.  If Not Listed Above, Highest Sala ry Held on a Federal Appointment
Dates Held:  From:  To:
SECTION E—APPOINTMENT DATA 	
1. Is there an INS Form I-9 on file? 	 Yes No  (Date  Certified)	
2.  Is the applicant a U.S.  citizen? 	
 Yes  No  If No, list country  citizen of	
(SEE REVERSE)

SECTION F—UNFAVORABLE DATA
1. Does OPF Contain Removal, Suspension, Within-Grade Denial, Discharge or Change to Lower Grade Actions?
Yes   	
 No  (Type of Action)
2. Is There Unfavorable Information in Other  Files, e.g. Letters of Warning, Admonishment, Reprimand, Suitability or Letter of D ecision on 
an Adverse Action?  Yes 
  	
 No   Don’t Know	
3. If “Yes” to Question 1 or 2, Name and Phone Nu mber of Person to Contact for More Information:
SECTION G—BENEFITS DATA  	
(HEALTH INSURANCE, LIFE INSURANCE)	
1. FEHB (Health) Waived Canceled—Show Date: Ineligible Enrolled—Show Code:
2. FEGLI (Life) Enrollment Code If “B” Waived—effective date
SECTION H—SERVICE OBLIGATION  
1. Does OPF Show Employee Has an Obligation to Remain in Gove rnment Service for a Specific Period Because of Training Received?
      No   Yes—Date Obligation Expires:	

2. Does Employee Have an Obligation Because of a Government-Paid Move?    No          Yes—Date Obligation Expires:	

SECTION I—PAYROLL & THRI FT SAVINGS PLAN DATA	
1. A.  Employees Payroll Office Address:
B.  Leave Balances: Annual SickIs Employee Currently  on LWOP?    No   Yes—Beginning Date:                                           NTE Date:	

C.  Person to Contact for Leave and Pay Information:	
(Na	me) 	(Phone Nu	mber)	
2. Year-To-Date FICA Deductions $ As Of:	(Date)	
3.  Does Employee Have Severance Pay  Entitlement? 	 No 	           Yes—Beginning Date:	
4. Thrift Savings Plan A.  TSP SCD B.  TSP Vesting Code C.  TSP Status Code D.  TSP Status Date   
5. TSP Allocation A.  Percent of Base Pay— .00% B.  Whole $ Amount—  .00
C.  G Fund Government Securities Investment— .00%
D.  F Fund Fixed Income  Index Investment— .00%
E.  C Fund Common Stock Index Investment— .00% Total— 100 .00%
6. Year-To-Date TSP Contributions $
7. TSP Loan Account Number: Payroll Deduction Account:
8. Name and Title of Official Certifying TSP Information
SECTION J—LOSING AGENCY RELEASE DATE  	
1. A.  Requested Release Date:
B.  Name and Phone Number of Person to Call For Release Date
2. Name, Title, and Phone Number of Person Giving Information	
(Name) (Phone Number)
(Name)                          	
                             (Title)                                  \
                 (Phone Number) (Name)                                                       (Title)
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