Form Ao 078 - Application For Judical Branch Federal Employment
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AO 78
(6/03)
APPLICATION FOR JUDICIAL BRANCH FEDERAL EMPLOYMENT
If You Need Additional Space, Continue Under “Remarks” Listing Item Number
Instructions - AO78
1. Name (Last, First, Middle Initial) Mr Miss. Mrs. Ms.
1 a. Gender
2. Phone Number
3. Social Security Number
’
’
F
M
4. Present Address (Street, City, State, Zip)
5. Place of Birth
City/State
Foreign Country
6. Other Names Previously Used for Employment Purposes
7. Date of Birth
GENERAL
’
’
8. Are you a U.S. Citizen?
YES
NO
— If not, give the Country of your citizenship
’
’
/
9. a. Were you ever a federal civilian employee?
YES
NO
— For highest civilian grade give:
grade
step
’
’
NO
b. Are you receiving a federal annuity payment?
YES
’
’
c. Are you receiving federal severance pay?
YES
NO
Former agency contact/tel:
10. Do you have any relatives that are Judges, Officers or employees of the United States Courts? If so, give their names, positions, and relationships to you.
’
’
YES
NO
’
’
11. Have you ever been discharged from a position or asked to resign under the threat of discharge?
YES
NO
If yes, explain under
Remarks at the end of this form.
’
’
th
12. Have you ever been convicted?
YES
NO
(You may omit: (1) offenses committed before your 18
birthday and adjudicated under a
juvenile offender law; (2) offenses adjudicated under a youth offender law; (3) offenses as to which the record has been expunged; (4) minor traffic
violations for which you paid a fine of $100 or less) If yes, explain under Remarks at the end of this form.
EDUCATION
13. a. Do you have a high school diploma or G.E.D. equivalent?
’
’
YES
NO
If yes, Date of Completion
Grade Point
Number of
b. Name and location of colleges or universities
Dates Attended
Degree
Date Received
Average and/or
attended (including law schools)
Quarter
Semester
scholastic standing
Credit Hours
Credit Hours
Chief Undergraduate Subjects
Quarter
Semester
Chief Graduate Subjects
Quarter
Semester
’
’
c.
Special skills, accomplishments, awards, honors, fraternities, sororities & societies (Specify)
YES
NO
’
’
’
d.
What was your scholastic standing in college/law school (Specify)?
UPPER ½
UPPER
a
UPPER ¼
’
’
e.
Were you a member of an editorial board of law review or a moot court participant?
YES
NO
f.
Other schools or training such as trade, vocational, Armed Forces, or business. Give for each: Name and location of school, dates attended,
subject studied, certificates, and any other pertinent data.
MILITARY SERVICE
’
’
14. a. Have you ever served on active duty with the military?
YES
NO
If yes, attach DD 214 member-4 copy, Notice of Separation.
’
’
b. Are you retired from military service?
YES
NO
APPLICANTS FOR LEGAL POSITIONS
’
’
15. a. Are you admitted to the Bar?
YES
NO
If yes, list the Bar(s) to which admitted and date(s) of admission:
’
’
ACTIVE
Is your Bar membership
INACTIVE
’
’
b. Did you attend a Bar review course?
YES
NO
List type of course:
Dates Attending: From:
To
mm/dd/yyyy
mm/dd/yyyy
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