Student Employment Program - Pre-Employment Eligibility Form Page 2
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3Student Employment Program
PRE-EMPLOYMENT ELIGIBILITY FORM
***This form must be completed and returned to the supervisor and must be approved by the Employment Officer (Human Resources)
before you can start work.***
SECTION I - To Be Completed by STUDENT
STUDENT'S NAME (Please print): _____________________________________________________________________
I certify that: 1) I am a U.S. citizen or a national (resident of American Somoa or Swains Island). 2) I am enrolled or have been
accepted for enrollment at an accredited institution as a degree-seeking student. Please attach most recent transcript which includes
grades. 3) My cumulative GPA from the most recent semester/quarter is at least a 2.0 on a 4.0 scale. 4) I intend to return to school
within 8 (eight) months of signing this form.
The type of degree/certificate/diploma to be obtained is _______________________________________________________________
The program completion date is projected to be _____________________________________________________________________
The school I attend operates on a ____ Quarter/ ____ Semester (check one) basis.
___________________________________________________________________________________________________________
Name of School
___________________________________________________________________________________________________________
Address of School
_____________________________________________
_________________________________________________
Date Attendance Began and/or Begins
Date Available for Work
______ I am at least 18 (for field-going positions) or will be by _________________________________________________________
--OR--
______ I am 16 (for office positions) or will be by ____________________________________________________________________
______ My completed application is attached.
______ My completed & signed OF-306 form is attached.
______ I have completed the education level indicated on the reverse of this form.
______ Current transcript(s) is attached.
I understand that in order for me to continue meeting the definition of student in accordance with 5 CFR 213.3202, I must
continue meeting all of the criteria in Section I above. When I no longer meet the definition of student, thus eligibility for the
SCEP or STEP, my employment under this appointment will be terminated. If SCEP, upon completion of academic
requirements, I may be converted to a permanent position within 120 days, if not converted at the end of 120 days then I will
be separated.
____________________________
_____________________________________________________________________
Date
Student Signature
SECTION 2 - To Be Completed by ADVISOR/COUNSELOR/REGISTRAR
Is student in good standing with the school? (Not on academic probation):
YES ________
NO _______
Does student have a GPA of at least 2.0 or higher?
YES _______
(if yes, latest GPA: ______)
NO _______
Is student enrolled at least half-time?
YES _______
NO _______
___________________________________________________
____________________
___________________________
Advisor/Counselor/Registrar (Printed, Signature and Title)
Date
Phone Number
SECTION 3 - To Be Completed by SELECTING OFFICIAL
____________________________________________________________________________
___________________________
Selecting Official Name (Printed and Signature)
Date
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