Optional Form 306 - Declaration For Federal Employment Page 3
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1
2
3Declaration for Federal Employment*
Form Approved:
OMB No. 3206-0182
(*This form may also be used to assess fitness for federal contract employment)
Additional Questions
14. Do any of your relatives work for the agency or government organization to which you are submitting this form?
YES
NO
(Include: father, mother, husband, wife, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece,
father-in-law,mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, stepfather, stepmother,
stepson, stepdaughter, stepbrother, stepsister, half brother, and half sister.) If "YES," use item 16 to provide the
relative's name,relationship, and the department, agency, or branch of the Armed Forces for which your relative
works.
15. Do you receive, or have you ever applied for, retirement pay, pension, or other retired pay based on military,
YES
NO
Federal civilian, or District of Columbia Government service?
Continuation Space / Agency Optional Questions
16. Provide details requested in items 7 through 15 and 18c in the space below or on attached sheets. Be sure to identify attached sheets with
your name, Social Security Number, and item number, and to include ZIP Codes in all addresses. If any questions are printed below, please
answer as instructed (these questions are specific to your position and your agency is authorized to ask them).
Certifications / Additional Questions
APPLICANT: If you are applying for a position and have not yet been selected, carefully review your answers on this form and any
attached sheets. When this form and all attached materials are accurate, read item 17, and complete 17a.
APPOINTEE: If you are being appointed, carefully review your answers on this form and any attached sheets, including any other application
materials that your agency has attached to this form. If any information requires correction to be accurate as of the date you are signing, make
changes on this form or the attachments and/or provide updated information on additional sheets, initialing and dating all changes and additions.
When this form and all attached materials are accurate, read item 17, complete 17b, read 18, and answer 18a, 18b, and 18c as appropriate.
17. I certify that, to the best of my knowledge and belief, all of the information on and attached to this Declaration for Federal Employment,
including any attached application materials, is true, correct, complete, and made in good faith . I understand that a false or fraudulent
answer to any question or item on any part of this declaration or its attachments may be grounds for not hiring me, or for firing
me after I begin work, and may be punishable by fine or imprisonment. I understand that any information I give may be investigated
for purposes of determining eligibility for Federal employment as allowed by law or Presidential order. I consent to the release of
information about my ability and fitness for Federal employment by employers, schools, law enforcement agencies, and other individuals
and organizations to investigators, personnel specialists, and other authorized employees or representatives of the Federal Government. I
understand that for financial or lending institutions, medical institutions, hospitals, health care professionals, and some other sources of
information, a separate specific release may be needed, and I may be contacted for such a release at a later date.
Appointing Officer:
17a. Applicant's Signature:
Date
Enter Date of Appointment or Conversion
(Sign in ink)
MM / DD / YYYY
17b. Appointee's Signature:
Date
(Sign in ink)
18. Appointee (Only respond if you have been employed by the Federal Government before): Your elections of life insurance during
previous Federal employment may affect your eligibility for life insurance during your new appointment. These questions are asked to help
your personnel office make a correct determination.
MM / DD / YYYY
18a. When did you leave your last Federal job?
DATE:
18b. When you worked for the Federal Government the last time, did you waive Basic Life
YES
NO
DO NOT KNOW
Insurance or any type of optional life insurance?
18c. If you answered "YES" to item 18b, did you later cancel the waiver(s)? If your answer to item
YES
NO
DO NOT KNOW
18c is "NO," use item 16 to identify the type(s) of insurance for which waivers were not
canceled.
U.S. Office of Personnel Management
Optional Form 306
Revised October 2011
Previous editions obsolete and unusable
5 U.S.C. 1302, 3301, 3304, 3328 & 8716
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