PRE EMPLOYMENT INFORMATION RECORDED by MissPowerPoint

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									AO 425

(Rev. 11/92)

Pre-Employment Information
, 3. Date of Birth: ,

SECTION A: 1. 2. 4. Name (Last, First, Middle): Previously Used Name(s): Social Security Number: Requesting Agency Name and Address:

5.

Name of Person Requesting Information:

Phone Number:

SECTION B: 1. 2. Currently employed Separated (Specify Date) Agency Name and Location of Official Personnel Folder (complete address):

3. 4. 5. 6.

Grade/Level Base:

Step/Rate COLA:

Salary

Pay Basis

If Salary Includes Coast of Living Adjustment (COLA), Indicate Base Salary and COLA Service Computation Date (SCD) 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 C. Check One and Specify Date: Retired 2. FEDERAL CIVILIAN: A. Civilian Retirement Date SECTION D—GRADE AND PAY DATA 1. 2A. 3A. 4. 5A. 5B. 6. 7. Date Entered Current Grade and Step/Rate Date of Last Within-Grade Increase (WGI) Highest Previous Grade/Step Held Was Salary Based on Special Rate or Locality? Is Applicant on Grade Retention? Retained Grade/Step: Is Applicant on Pay Retention? Yes No Yes 2B. If WGI Was Denied, Date of Denial 3B. Dates Held: From: Yes No 5C. Date Grade Retention Began No To: Salary: B. Retirement System Paying Annuity B. Retired Rank Transferred to Fleet Reserve (Date)

If Not Listed Above, Highest Salary Held on a Federal Appointment Dates Held: From: To:

SECTION E—APPOINTMENT DATA 1. 2. Is there an INS Form I-9 on file? Is the applicant a U.S. citizen? Yes Yes No No (Date Certified) If No, list country citizen of
(SEE REVERSE)

SECTION F—UNFAVORABLE DATA 1. 2. 3. Does OPF Contain Removal, Suspension, Within-Grade Denial, Discharge or Change to Lower Grade Actions? Yes No (Type of Action) Is There Unfavorable Information in Other Files, e.g. Letters of Warning, Admonishment, Reprimand, Suitability or Letter of Decision on an Adverse Action? Yes No Don’t Know If “Yes” to Question 1 or 2, Name and Phone Number of Person to Contact for More Information:

SECTION G—BENEFITS DATA (HEALTH INSURANCE, LIFE INSURANCE) 1. 2. FEHB (Health) Ineligible FEGLI (Life) Waived Enrollment Code Canceled—Show Date: If “B” Waived—effective date Enrolled—Show Code:

SECTION H—SERVICE OBLIGATION 1. Does OPF Show Employee Has an Obligation to Remain in Government Service for a Specific Period Because of Training Received? No 2. Yes—Date Obligation Expires: No Yes—Date Obligation Expires:

Does Employee Have an Obligation Because of a Government-Paid Move?

SECTION I—PAYROLL & THRIFT SAVINGS PLAN DATA 1. A. Employees Payroll Office Address:

B. Leave Balances:

Annual No

Sick Yes—Beginning Date:
(Name)

Is Employee Currently on LWOP?

NTE Date:
(Phone Number)

C. Person to Contact for Leave and Pay Information: 2. 3. 4. 5. Year-To-Date FICA Deductions $ No As Of:
(Date)

Does Employee Have Severance Pay Entitlement? Thrift Savings Plan TSP Allocation A. TSP SCD C. TSP Status Code A. Percent of Base Pay— B. Whole $ Amount—

Yes—Beginning Date: B. TSP Vesting Code D. TSP Status Date .00% .00 .00% .00% Total— .00% 100 .00%

C. G Fund Government Securities Investment— D. F Fund Fixed Income Index Investment— E. C Fund Common Stock Index Investment— 6. 7. 8. Year-To-Date TSP Contributions TSP Loan Account Number: Name and Title of Official Certifying TSP Information $ Payroll Deduction Account:
(Name)

(Title)

SECTION J—LOSING AGENCY RELEASE DATE 1. 2. A. Requested Release Date: B. Name and Phone Number of Person to Call For Release Date Name, Title, and Phone Number of Person Giving Information
(Name) (Title) (Name) (Phone Number)

(Phone Number)

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