Career-Conditional Appointment

New EPA employees need to complete the following forms to set up their personnel record, establish benefits and generate payroll information. Bring the original forms (and in some instances extra copies) with you to Orientation. Use black ink and make a copy of each form for your own files. (Bookmark this page in your browser, so that you can easily return to it after completing and printing out each form.)

Form/Title	Remarks
Appointment Affidavits (PDF 348 KB)	Print your full name (no initials) on the third line, after the word "I". This is the document with which you will take your Oath of Office; the rest of the blanks will be filled in after you have been sworn in at Orientation.
Declaration for Federal Employment, OF-306 (PDF 93 KB)	This form will be used to determine your acceptability for Federal employment. Under Item 6, day phone number, enter the phone number for your Supervisor as listed in our Confirmation of Employment Letter. Sign Item 17A but do not sign Item 17B. Item 17B will be signed after you have taken the Oath of Office at Orientation. Bring both the original signed form and a copy of it to Orientation.
Designation of Beneficiary Form for Life Insurance (FEGLI), SF-2823 (PDF 120 KB)	This form is optional -- please read the instructions carefully. This form appears in duplicate on the website, but you will need to complete only one copy. Complete Parts A, B, and C down to the spaces provided for your signature and the date. Sign and date the document in the presence of two witnesses, neither of whom can be listed as your beneficiary. At Part D, have each witness sign and provide a home or work address.
Designation of Beneficiary Form for Federal Employees' Retirement System (FERS), SF-3102 (PDF 80 KB)	This form is optional -- please read the instructions carefully. This form appears in duplicate on the website, but you will need to complete only one copy. Complete Parts A and B down to the spaces provided for your signature and the date. Sign and date the document in the presence of two witnesses, neither of whom can be listed as your beneficiary. Have the witnesses complete and sign Part C and provide a home or work address. Be sure to fill in your name and address in the box provided at the bottom of the form so that your file copy can be returned.
To learn more about the Federal Employees' Retirement System (FERS):	Office of Personnel Management (FERS)
Employee Health Benefits, SF-2809 (PDF 482 KB)	This form is optional -- please read the instructions carefully. This is the Employee Health Benefits Election Form (FEHBP). This form appears in triplicate on the website, but you will need to complete only one copy. Complete the form and sign and date it at Part G. You have 60 days from the date of your current appointment to enroll in a plan. You must complete the form even if you decline enrollment.
To learn more about the FEHB Program:	FEHB 2005 Guide to Federal Employees Health Benefits Plans (PDF 513 KB)
To learn about the Flexible Spending Accounts program:	Office of Personnel Management (FSA FEDS)
To learn about the Long-term Care Insurance program:	Office of Personnel Management (FLTCIP) Long Term Care Partners
Employee Benefits Program - to learn about all benefits for new Federal employees:	Guide to Federal Benefits Programs for New Employees
Employee Life Insurance Election Form, SF-2817 (PDF 160 KB)	This form is optional -- please read the instructions carefully. This is the Federal Employees" Group Life Insurance Program (FEGLI). This form appears in triplicate on the website, but you will need to complete only one copy. You have 30 days from your enter-on-duty date to enroll in the Program.
Employment Eligibility Verification, Form I-9 (PDF 246 KB)	This form is used to verify your citizenship and eligibility to work in the United States. Complete Section 1 and sign and date the form. Refer to the List of Acceptable Documents on the back of the form before completing Section 2. If you have any document listed in List A, you need only complete the information for list A. Name the document, provide its document number, and the expiration date, if any. (A frequently-cited document is a current or expired U.S. Passport.) If you do not have any document from List A, select one from List B and List C, and provide the same information. Be sure to bring the documents you have listed on this form for verification during the Orientation Briefing.
FastStart Direct Deposit Enrollment or Exemption Application, FSM-2231 (PDF 104 KB)	EPA requires that employees receive payroll payments by direct deposit. Complete this form to allow for the electronic transfer of your paycheck, travel reimbursements, etc., into your checking or savings account at your financial institution.
To learn more about the FEGLI Program:	Federal Employees' Group Life Insurance
Questionnaire for Non-Sensitive Positions, SF-85 (PDF 336 KB)	This form must be completed in order to process your background investigation. Read the instructions carefully before proceeding. When you have completed, signed and dated the form, make an extra copy to keep for your own records.
Optional Application for Federal Employment, OF-612 (PDF 132 KB)	You will need to bring a résumé. You can complete the OPM OF-612 located here, make a copy of your EZHire application used to acquire this position or provide your résumé in a different format.
Race and National Origin Identification, SF-181 (PDF 99 KB)	Fill in the information requested at the top of the form. Read the introductory information, and check off the category which most closely describes your heritage.
Self-Identification of Handicap, SF-256 (PDF 191 KB)	Read the sections in the form entitled "Definition of a Handicap" and "To the Employee," and select the code which most closely describes you, entering the code at the top of the page.
Statement of Prior Federal Service, SF-144 (PDF 214 KB)	Complete this form only if you have prior Federal civilian or military service. Your length of service affects your leave and retirement benefits.
Tax Withholding Form—District of Columbia (PDF 217 KB)	The "Employee Withholding Allowance Certificate" is the D-4, District of Columbia form. Complete, sign and date this form only if you are a resident of the District of Columbia, or will have become one by the time you have begun working at EPA.
Tax Withholding Form—Federal (PDF 52 KB)	The "Employee's Withholding Allowance Certificate" is the Federal tax withholding form, W-4. It is used to determine the correct amount of Federal income tax to be withheld from your biweekly earnings based on the number of exemptions that you claim. Use the Worksheet to determine the number of withholding allowances that you are entitled to claim. You need to complete, sign and date this form.
Tax Withholding Form—Generic State (PDF 167 KB)	If you are not a resident of the District of Columbia, Maryland or Virginia -- or wish to retain residency in your home state - you must fill out a published form or an Internet version of your State's Withholding Exemption Certificate. If you are not sure whether your state has a withholding exemption certificate, a useful place to visit is the Federation of Tax Administrators website. If none exists, complete, sign and date this generic form.
Tax Withholding Form—Maryland (PDF 45 KB)	The "Employee's Maryland Withholding Exemption Certificate" is the Maryland Form, MW-507. Complete, sign and date this form only if you are a resident of the State of Maryland, or will have become one by the time you have begun working at EPA.
Tax Withholding Form—Virginia (PDF 13 KB)	The "Employee's Virginia Income Tax Withholding Exemption Certificate" is the VA-4 form. Complete, sign and date this form only if you are a resident of the Commonwealth of Virginia, or will have become one by the time you have begun working at EPA.
Thrift Savings Plan Election Form, TSP-1 (PDF 19 KB)	This form is optional -- please read the instructions carefully. This is the Thrift Savings Plan Election Form. You have 60 days from your first day of employment to submit a completed TSP Election Form, or you must wait until Open Season -- April 15 through June 30. Complete Parts I and II of the Thrift Savings Plan Election Form, TSP-1, and sign and date the form at Part IV. If you have not joined the TSP program previously and are under FERS, your Agency-matching contributions will begin six months from the date when you join the program.
Thrift Savings Plan Designation of Beneficiary Form, TSP-3 (PDF 38 KB)	This form is optional -- please read the instructions carefully. This is the TSP Designation of Beneficiary Form. Complete Parts I and II. Sign and date Part III in the presence of two witnesses who are age 21 or older and are not listed as your TSP account beneficiaries. Have the witnesses print and sign their names.
To learn more about the Thrift Savings Plan (TSP):	Thrift Savings Plan
Unpaid Compensation, Designation of Beneficiary Form, SF-1152 (PDF 167 KB)	This form is optional -- please read the instructions carefully. This form appears in duplicate on the website, but you need only complete one copy. Complete Part A, and Part B down to the spaces provided for your signature and date. Sign and date the document in the presence of two witnesses, neither of whom can be listed as your beneficiary. At Part C, have each witness sign and provide a home or work address. Be sure to fill in your name and address in the box provided at the bottom of the form so that your file copy can be returned.

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Career-Conditional Appointment

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