Entry on Duty

Welcome to the State Department! This new employee pre-appointment package contains important forms that must be completed prior to your first day of employment at the State Department.

Several of the forms can be filled out on-line, or they may be printed and completed manually. Forms on this site are either in PDF* or FAR** formats. Be aware that data entered on the electronic forms will not be saved and your input will be deleted when you exit the form. Please review each form for accuracy and print before continuing to the next form. As you work through the pre-appointment package, use the checklist of the documents provided as your guide. We also recommend that you keep copies of these documents for your records.

Please follow the instructions for each form in the package carefully to ensure successful completion. Once you are satisfied that all forms are completed correctly, sign and date the forms (if instructed to do so) and bring them to orientation. Should you have any specific questions, they will be answered during your orientation session.

Again, welcome to the State Department.

* Note about Forms: Many files available on the internet and on OPM's websites are provided in PDF (Portable Document Format) files. Files ending in .pdf are PDF files. This format preserves the look and feel of the original printed page.

** FAR format: FAR is the Department of State's standard form format. In order to use the FAR format, you must download the filler application.

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Civil Service Employees: Mandatory Forms +

The following forms are required for New Civil Service Employees:

  1. Department of State Drug Testing Policy

    Please read, sign and date.

  2. D-4, Employee's Withholfding Allowance Certificate (DC)

    For residents of the District of Columbia:

    • Enter your name, address, and social security number.
    • Select your filing status and the total number of allowances you are claiming.If you are unsure about the number of allowances to claim, use the Worksheet provided on Form D-4 to determine the correct deduction.
    • Sign and date the form.


  3. DS Locator Sheet

    Complete the form with the applicable information and date.

  4. DS-1031A, U.S. Department of State Biographic Data Sheet

    Please complete the form annotating all colleges that you attended and list all of your dependents. Sign and date the form.

  5. DS-4145, Continued Service Agreement

    Please read, sign and date.

  6. I-9, Employment Eligibility Verification
    • Complete, sign and date Section 1 only.
    • You must bring two forms of identification with you to orientation. You will be asked to show proof of eligibility for employment in the U.S. You will find a list of acceptable documents on the third page of the I-9 form.
    • You must bring one document from List A; OR
    • One document from List B and one document for List C.


  7. Information on Insurance Benefits

    Information regarding the Federal Employees' Group Life Insurance (FEGLI), Federal Employees Health Benefits (FEHB) Program, Federal Long Term Care Insurance Program (FLTCIP).

  8. MW-507, Employee's Maryland Withholding Exemption Certificate Form

    If you are a Maryland resident:

    • Enter your name, social security number, address and county of residence.
    • Indicate the number of exemptions you are claiming.If you are unsure about the number of exemption to claim, use the Worksheet at the bottom of the form to determine the correction deduction.
    • Sign and date the form.


  9. OF-306, Declaration of Federal Employment
    • Provide complete answers and check the boxes that apply to you.
    • Please remember to clarify your responses to questions 8 through 13 and question 17 in the space provided under number 15.
    • If you answer "Yes" to any question from 8 through 12, please immediately telephone the Human Resources Specialist who offered you employment.
    • For number 15, your answer should still be "Yes" if you applied for any of the types of pay listed, but were denied.
    • When you complete this form sign and date after number 17a only.


  10. SF-144, Statement of Prior Federal Service
    • This form will be used to allow the US Department of State to verify your pervious federal employment service.
    • In number 5, ensure that you annotate all federal agencies of employment, dates of employment and type of appointment.
    • In number 6, annotate absences, if applicable.
    • In box number 7, annotate military service, dates and type of discharge. Sign and date the form.


  11. SF-181, Ethnicity and Race Identification

    Your completion of this form and providing this information is voluntary.Your failure to do so will have no effect on you or your Federal employment. However, if you fail to provide the information, the employing agency will attempt to identify your race and national origin by visual perception.

    • Check the box next to the category that defines your racial and national origin.
    • Mark only one box.


  12. SF-256, Self-Identification of Handicap

    Self Identification of handicap status is voluntary. The Privacy Act statement and purpose for handicap data collection is explained on the back of the form.

    • Read through the definitions provided and enter the code of the one which best described your status.
    • Enter only one code.


  13. SF-1199A, Direct Deposit Sign-Up Form

    Completion of this form is mandatory for the timely payment of your biweekly salary.

    Section 1

    • A - Enter your name, address, and telephone number.
    • B - Skip
    • C - Enter
    • D - Check next to your account type.
    • E - Enter your account number. Do you leave blank spaces between the numbers. You may use dashes if they are part of your account number.
    • F - Self-explanatory
    • G - Skip

    Joint Account Holders' Certification: If there are two names on the account, both account holders must sign here.

    Section 2

    • Government Agency Name: Department of State
    • Government Agency Address: Washington, DC 20522

    Section 3

    • This must be completed, signed, and dated by your financial institution and given back to you.


  14. DS-7665 Unemployment Insurance Benefits

    Please read, sign and date.

  15. VA-4, Virginia Employee's Withholding Exemption Certificate

    If you are a Virginia resident:

    • Enter your social security number, name and address.
    • Indicate the number of withholding exemptions you are claiming.If you are unsure about the number of exemptions to claim, use the Personal Exemption worksheet on the top of the Form VA-4 to determine the correct deduction.
    • Sign and date the form.


  16. Voluntary Separation Incentive Payments

    Check the applicable box, sign and date.

  17. W-4, Employee's Withholding Allowance Certificate Form
    • Enter your name, address, and social security number.
    • Indicate the tax rate category and number of exemptions you wish to claim on this Federal income tax withholding form.
    • If you are unsure about the number of exemptions to claim, you can use the Personal Allowances Worksheet at the top of the W-4 form, or, the Deductions and Adjustment Worksheet on the reverse of the form. Additional withholding advice should be sought from a tax professional.
    • Sign and date the form.
Civil Service Employees: Optional Benefits Coverage Forms +

Based on your benefits elections, the following forms may be required:

  1. FEHB Premium Conversion Waiver/Election Form

    Premium Conversion is a "pre-tax" arrangement under which the part of your salary that goes for health insurance premiums will be non-taxable. This means that you save on Federal income tax and FICA taxes (Social Security and Medicare taxes). In most cases, you'll also save on State income tax and local income tax. The payroll office will sign you up for Premium Conversion automatically. You don't need to fill out a form. You do have a choice, though, to waive premium conversion despite the savings.

  2. SF-813, Verification of a Military Retiree's Service in Non-Wartime Campaigns or Expeditions

    If a military retiree, please complete and send to respective branch of service along with a copy of your DD 214 for verification of campaigns and/or expeditions.

  3. SF-1152, Unpaid Compensation Designation of Beneficiary

    Standard rules determine who is eligible to receive these payments. If you are satisfied with the order of payment for that program, you do not have to take any action. But if you want these funds to go to someone else, you need to file a Designation of Beneficiary for that program.

    If you die while you are a Federal employee, payments will be made in the below order as set and dictated by the law as follows:

    • To your widow or widower
    • If none, to your child or children in equal shares, with the share of any deceased child distributed among the child's descendants
    • If none, to your parents in equal shares or the entire amount to your surviving parent>
    • If none, to the executor or administrator of your estate
    • If none, to your next of kin under the laws of the state where you lived at the time of your death

    Please read carefully the specific instructions on each designation form before making your designation.

  4. SF-2809, Health Benefits Election Form

    The Federal Employees Health Benefits Program (FEHB) is one of the most valuable benefits of Federal employment, but coverage is not automatic — you must select one of the more than 100 available health plans in order to be covered.

    You have 60 days from your entry on duty date to sign-up for a health insurance plan. If you don't make an election, you are considered to have declined coverage and you must wait until open season to enroll.

    VERY IMPORTANT: Enrollment is not retroactive, and it cannot be made effective the day you enter on duty as you must have been in a pay status during some part of the pay period which precedes the one in which your enrollment becomes effective. Once this requirement has been met your enrollment will become effective on the first day of the first pay period that begins after your employing office receives your enrollment request. Thus the earliest that your health insurance can possibly become effective is the beginning of the pay period that begins after the pay period in which you are hired. You cannot be reimbursed for any medical expenses incurred prior to the effective date. You need to consider this in canceling any other health insurance coverage you may already have, and for scheduling of doctor visits or tests.

    Although you have 60 days to make your election, it is to your advantage to make this election soon in order to be covered in case of accident or illness. There is no retroactive coverage of your expenses prior to the effective date of your coverage. The policy will begin coverage on the effective date, however, and will cover expenses occurring on or after that date, even for conditions occurring before that date. Additional information on all current health plans is available at: http://www.opm.gov/insure/health/search/plansearch.aspx

  5. SF-2817, Life Insurance Election

    If you're in a FEGLI-eligible position, you're automatically enrolled in Basic life insurance, which is effective on the first day you enter in a pay and duty status, UNLESS you waive this coverage before the end of your first pay period. Optional insurance is NOT automatic – you have to take action to elect it.

    If you want Optional Insurance, you must elect coverage within 60 calendar days after becoming eligible. If you do not make an election, you are considered to have waived optional insurance.

    No proof of insurability is required for the Basic insurance you get upon being hired or any optional insurance you sign-up for during the first 60 days. Proof of insurability may be required for insurance changes after that time.

  6. SF-2823, Life Insurance Designation of Beneficiary

    Standard rules determine who is eligible to receive these payments. If you are satisfied with the order of payment for that program, you do not have to take any action. But if you want these funds to go to someone else, you need to file a Designation of Beneficiary for that program.

    If you die while you are a Federal employee, payments will be made in the below order as set and dictated by the law as follows:

    • To your widow or widower
    • If none, to your child or children in equal shares, with the share of any deceased child distributed among the child's descendants
    • If none, to your parents in equal shares or the entire amount to your surviving parent>
    • If none, to the executor or administrator of your estate
    • If none, to your next of kin under the laws of the state where you lived at the time of your death

    NOTE: If a qualifying court order or an assignment of benefits is on file for the Federal Employees’ Group Life Insurance (FEGLI) Program, the court order or assignment takes precedence over any designation of beneficiary and the above normal order of precedence.

    Please read carefully the specific instructions on each designation form before making your designation.

  7. SF-3102, FERS Designation of Beneficiary Form or SF 2808 (CSRS)

    Standard rules determine who is eligible to receive these payments. If you are satisfied with the order of payment for that program, you do not have to take any action. But if you want these funds to go to someone else, you need to file a Designation of Beneficiary for that program.

    If you die while you are a Federal employee, payments will be made in the below order as set and dictated by the law as follows:

    • To your widow or widower
    • If none, to your child or children in equal shares, with the share of any deceased child distributed among the child's descendants
    • If none, to your parents in equal shares or the entire amount to your surviving parent.
    • If none, to the executor or administrator of your estate
    • If none, to your next of kin under the laws of the state where you lived at the time of your death

    Please read carefully the specific instructions on each designation form before making your designation.

  8. TSP-1, Thrift Savings Plan Election Form (link goes to www.tsp.gov)

    If your appointment confers eligibility for the Federal Employees Retirement System your agency will automatically enroll you in this program.

    Almost all new employees are automatically covered by the Federal Employees Retirement System (FERS). FERS is a three-tiered retirement plan. The three tiers are:

    • Social Security Benefits
    • Basic Benefit Plan
    • Thrift Savings Plan

    You pay full Social Security taxes and a small contribution to the Basic Benefit Plan. In addition, your agency will set up a Thrift Savings Plan account for you and will automatically contribute an amount equal to 1% of your basic pay each pay period. These Agency Automatic (1%) Contributions are not taken out of your salary, and your agency makes these contributions whether or not you contribute your own money to the TSP.

    You are also able to make tax-deferred contributions to the TSP and a portion is matched by the Government. Your agency will invest $1.00 for every $1.00 you invest for the first 3 percent of your basic salary, and 50 cents for each $1.00 you invest for the next 2 percent of your basic salary. The agency contributions are not taken out of your salary; they are an extra benefit to you.

    You can start, change, stop, and resume TSP contributions at any time. There is no waiting period.

    The best way to assure that your retirement income meets your needs is to start investing in the Thrift Savings Plan at the beginning of your Federal service, and to continue to do so throughout your career. It is particularly important for higher-paid employees to save enough through the TSP since Social Security replaces a smaller percentage of the income of higher-paid workers than it does for lower-paid workers. You may contribute up to the maximum annual amount permitted by Internal Revenue Service regulations, currently $16,500 percent of your basic pay.

  9. TSP-3, Thrift Savings Plan Designation of Beneficiary (link goes to www.tsp.gov)

    Standard rules determine who is eligible to receive these payments. If you are satisfied with the order of payment for that program, you do not have to take any action. But if you want these funds to go to someone else, you need to file a Designation of Beneficiary for that program.

    If you die while you are a Federal employee, payments will be made in the below order as set and dictated by the law as follows:

    • To your widow or widower
    • If none, to your child or children in equal shares, with the share of any deceased child distributed among the child's descendants
    • If none, to your parents in equal shares or the entire amount to your surviving parent.
    • If none, to the executor or administrator of your estate
    • If none, to your next of kin under the laws of the state where you lived at the time of your death

    Please read carefully the specific instructions on each designation form before making your designation.

Foreign Service Employees: Mandatory Forms +

I am a new foreign service government employee or returning to the foreign service after a break.

MANDATORY

All mandatory forms must be sent to your HR Officer prior to your reporting date.

The following forms are required for Foreign Service Employees:

  • Agreement To Join The Foreign Service

    The Agreement to Join the Foreign Service is the last page of your confirmation letter. Please sign that form and fax it immediately and send the original with the other completed forms.

  • DS-1031A, US Department of State Biographic Data Sheet
    • Please complete the form annotating all colleges that you attended and list all of your dependents. Sign and date the form.
  • DS-4145, Continued Service Agreement

    Please read, sign and date.

  • DS-4146, Foreign Service Assignments and Policy Commitments

    Please read, sign and date.

  • DS-5002, Designation of Beneficiary

    Standard rules determine who is eligible to receive these payments. If you are satisfied with the order of payment for that program, you do not have to take any action. But if you want these funds to go to someone else, you need to file a Designation of Beneficiary for that program.

    If you die while you are a Federal employee, payments will be made in the below order as set and dictated by the law as follows:

    • To your widow or widower
    • If none, to your child or children in equal shares, with the share of any deceased child distributed among the child's descendants
    • If none, to your parents in equal shares or the entire amount to your surviving parent
    • If none, to the executor or administrator of your estate
    • If none, to your next of kin under the laws of the state where you lived at the time of your death

    Please read carefully the specific instructions on each designation form before making your designation.

  • DS-7663, Department of State Drug Testing Policy
    • Please read, sign and date.


  • I-9, Employment Eligibility Verification
    • Complete, sign and date Sections 1 and 2.
    • You must bring two forms of identification with you to orientation. You will be asked to show proof of eligibility for employment in the U.S. You will find a list of acceptable documents on the third page of the I-9 form.
    • You must bring one document from List A; OR
    • One document from List B and one document for List C.

  • Medical Update Form

    Please read, print your name, social security number, date of birth and sign.

  • SF-1152, Unpaid Compensation Designation of Beneficiary

    Standard rules determine who is eligible to receive these payments. If you are satisfied with the order of payment for that program, you do not have to take any action. But if you want these funds to go to someone else, you need to file a Designation of Beneficiary for that program.

    If you die while you are a Federal employee, payments will be made in the below order as set and dictated by the law as follows:

    • To your widow or widower
    • If none, to your child or children in equal shares, with the share of any deceased child distributed among the child's descendants
    • If none, to your parents in equal shares or the entire amount to your surviving parent>
    • If none, to the executor or administrator of your estate
    • If none, to your next of kin under the laws of the state where you lived at the time of your death

    Please read carefully the specific instructions on each designation form before making your designation.

  • SF-1199A, Direct Deposit Sign-Up Form

    Completion of this form is mandatory for the timely payment of your biweekly salary.

    Section 1

    • A - Enter your name, address, and telephone number.
    • B - Skip
    • C - Enter your social security number
    • D - Check next to your account type.
    • E - Enter your account number. Do you leave blank spaces between the numbers. You may use dashes if they are part of your account number.
    • F - Self-explanatory
    • G - Skip

    Joint Account Holders' Certification:

    If there are two names on the account, both account holders must sign here.

    Section 2

    • Government Agency Name: Department of State
    • Government Agency Address: Washington, DC 20522

    Section 3 f

    • This must be completed, signed, and dated by your financial institution and given back to you; or provide a voided check.
  • SF-144, Statement of Prior Federal Service
    • This form will be used to allow the US Department of State to verify your pervious federal employment service.
    • In number 5, ensure that you annotate all federal agencies of employment, dates of employment and type of appointment.
    • In number 6, annotate absences, if applicable.
    • In box number 7, annotate military service, dates and type of discharge. Sign and date the form.
  • SF-181, Ethnicity and Race Identification

    Your completion of this form and providing this information is voluntary.Your failure to do so will have no effect on you or your Federal employment. However, if you fail to provide the information, the employing agency will attempt to identify your race and national origin by visual perception.

    • Check the box next to the category that defines your racial and national origin.
    • Mark only one box.
  • SF-256, Self-Identification of Handicap

    Self Identification of handicap status is voluntary. The Privacy Act statement and purpose for handicap data collection is explained on the back of the form.

    • Read through the definitions provided and enter the code of the one which best described your status.
    • Enter only one code.
  • SF-2809, Health Benefits Election Form

    The Federal Employees Health Benefits Program (FEHB) is one of the most valuable benefits of Federal employment, but coverage is not automatic — you must select one of the more than 100 available health plans in order to be covered.

    You have 60 days from your entry on duty date to sign-up for a health insurance plan. If you don't make an election, you are considered to have declined coverage and you must wait until open season to enroll.

    VERY IMPORTANT: Enrollment is not retroactive, and it cannot be made effective the day you enter on duty as you must have been in a pay status during some part of the pay period which precedes the one in which your enrollment becomes effective. Once this requirement has been met your enrollment will become effective on the first day of the first pay period that begins after your employing office receives your enrollment request. Thus the earliest that your health insurance can possibly become effective is the beginning of the pay period that begins after the pay period in which you are hired. You cannot be reimbursed for any medical expenses incurred prior to the effective date. You need to consider this in canceling any other health insurance coverage you may already have, and for scheduling of doctor visits or tests.

    Although you have 60 days to make your election, it is to your advantage to make this election soon in order to be covered in case of accident or illness. There is no retroactive coverage of your expenses prior to the effective date of your coverage. The policy will begin coverage on the effective date, however, and will cover expenses occurring on or after that date, even for conditions occurring before that date. Additional information on all current health plans is available at: http://www.opm.gov/insure/health/search/plansearch.aspx

  • SF-2817, Life Insurance Election

    If you're in a FEGLI-eligible position, you're automatically enrolled in Basic life insurance, which is effective on the first day you enter in a pay and duty status UNLESS you waive this coverage before the end of your first pay period. You do NOT get any Optional insurance automatically – you have to take action to elect it.

    You have 60 days from your entry date to sign up for any Optional life insurance. If you do not make an election, you are considered to have waived optional insurance.

    No proof of insurability is required for the Basic insurance you get upon being hired or any optional insurance you sign-up for during the first 60days. Proof of insurability may be required for insurance changes after that time.

  • SF-2823, Life Insurance Designation of Beneficiary

    Standard rules determine who is eligible to receive these payments. If you are satisfied with the order of payment for that program, you do not have to take any action. But if you want these funds to go to someone else, you need to file a Designation of Beneficiary for that program.

    If you die while you are a Federal employee, payments will be made in the below order as set and dictated by the law as follows:

    • To your widow or widower
    • If none, to your child or children in equal shares, with the share of any deceased child distributed among the child's descendants
    • If none, to your parents in equal shares or the entire amount to your surviving parent>
    • If none, to the executor or administrator of your estate
    • If none, to your next of kin under the laws of the state where you lived at the time of your death

    NOTE: If a qualifying court order or an assignment of benefits is on file for the Federal Employees’ Group Life Insurance (FEGLI) Program, the court order or assignment takes precedence over any designation of beneficiary and the above normal order of precedence.

    Please read carefully the specific instructions on each designation form before making your designation.

  • TSP-1, Thrift Savings Plan Election Form (link goes to www.tsp.gov)

    If your appointment confers eligibility for the Federal Employees Retirement System your agency will automatically enroll you in this program.

    Almost all new employees are automatically covered by the Federal Employees Retirement System (FERS). FERS is a three-tiered retirement plan. The three tiers are:

    • Social Security Benefits
    • Basic Benefit Plan
    • Thrift Savings Plan

    You pay full Social Security taxes and a small contribution to the Basic Benefit Plan. In addition, your agency will set up a Thrift Savings Plan account for you and will automatically contribute an amount equal to 1% of your basic pay each pay period. These Agency Automatic (1%) Contributions are not taken out of your salary, and your agency makes these contributions whether or not you contribute your own money to the TSP.

    You are also able to make tax-deferred contributions to the TSP and a portion is matched by the Government. Your agency will invest $1.00 for every $1.00 you invest for the first 3 percent of your basic salary, and 50 cents for each $1.00 you invest for the next 2 percent of your basic salary. The agency contributions are not taken out of your salary; they are an extra benefit to you.

    You can start, change, stop, and resume TSP contributions at any time. There is no waiting period.

    The best way to assure that your retirement income meets your needs is to start investing in the Thrift Savings Plan at the beginning of your Federal service, and to continue to do so throughout your career. It is particularly important for higher-paid employees to save enough through the TSP since Social Security replaces a smaller percentage of the income of higher-paid workers than it does for lower-paid workers. You may contribute up to the maximum annual amount permitted by Internal Revenue Service regulations, currently $17,500 percent of your basic pay.

  • Voluntary Separation Incentive Payments
    • Check the applicable box, sign and date.
  • W-4, Employee's Withholding Allowance Certificate Form
    • Enter your name, address, and social security number.
    • Indicate the tax rate category and number of exemptions you wish to claim on this Federal income tax withholding form.
    • If you are unsure about the number of exemptions to claim, you can use the Personal Allowances Worksheet at the top of the W-4 form, or, the Deductions and Adjustment Worksheet on the reverse of the form. Additional withholding advice should be sought from a tax professional.
    • Sign and date the form.


Foreign Service Employees: Optional Benefits Coverage Forms +

Based on your benefits elections, the following forms may be required:

  • D-4, Employee's Withholding Allowance Certificate (DC)

    For residents of the District of Columbia:

    • Enter your name, address, and social security number.
    • Select your filing status and the total number of allowances you are claiming.If you are unsure about the number of allowances to claim, use the Worksheet provided on Form D-4 to determine the correct deduction.
    • Sign and date the form.


  • DS Locator Sheet
    • Complete the form with the applicable information and date.


  • MW-507, Employee's Maryland Withholding Exemption Certificate Form

    If you are a Maryland resident:

    • Enter your name, social security number, address and county of residence.
    • Indicate the number of exemptions you are claiming.If you are unsure about the number of exemption to claim, use the Worksheet at the bottom of the form to determine the correction deduction.
    • Sign and date the form.


  • OF-306, Declaration of Federal Employment
    • Provide complete answers and check the boxes that apply to you.
    • Please remember to clarify your responses to questions 8 through 13 and question 17 in the space provided under number 15.
    • If you answer "Yes" to any question from 8 through 12, please immediately telephone the Human Resources Specialist who offered you employment.
    • For number 15, your answer should still be "Yes" if you applied for any of the types of pay listed, but were denied.
    • When you complete this form sign and date after number 17a only.


  • TSP-3, Thrift Savings Plan Designation of Beneficiary

    Standard rules determine who is eligible to receive these payments. If you are satisfied with the order of payment for that program, you do not have to take any action. But if you want these funds to go to someone else, you need to file a Designation of Beneficiary for that program.

    If you die while you are a Federal employee, payments will be made in the below order as set and dictated by the law as follows:

    • To your widow or widower
    • If none, to your child or children in equal shares, with the share of any deceased child distributed among the child's descendants
    • If none, to your parents in equal shares or the entire amount to your surviving parent.
    • If none, to the executor or administrator of your estate
    • If none, to your next of kin under the laws of the state where you lived at the time of your death

    Please read carefully the specific instructions on each designation form before making your designation.

  • Unemployment Insurance Benefits
    • Please read, sign and date.


  • VA-4, Virginia Employee's Withholding Exemption Certificate

    If you are a Virginia resident:

    • Enter your social security number, name and address.
    • Indicate the number of withholding exemptions you are claiming.If you are unsure about the number of exemptions to claim, use the Personal Exemption worksheet on the top of the Form VA-4 to determine the correct deduction.
    • Sign and date the form.
Temporary Employees: Mandatory forms +

I am an employee who is a student or I have been hired on a time limited appointment.

  • Department of State Drug Testing Policy
    • Please read, sign and date.


  • D-4, Employee's Withholding Allowance Certificate (DC)

    For residents of the District of Columbia:

    • Enter your name, address, and social security number.
    • Select your filing status and the total number of allowances you are claiming.If you are unsure about the number of allowances to claim, use the Worksheet provided on Form D-4 to determine the correct deduction.
    • Sign and date the form.


  • DS-1031A, U.S. Department of State Biographic Data Sheet
    • Please complete the form annotating all colleges that you attended and list all of your dependents. Sign and date the form.


  • DS-4145, Continued Service Agreement

    Please read, sign and date.

  • DS Locator Sheet
    • Complete the form with the applicable information and date.


  • I-9, Employment Eligibility Verification
    • Complete, sign and date Section 1 only.
    • You must bring two forms of identification with you to orientation. You will be asked to show proof of eligibility for employment in the U.S. You will find a list of acceptable documents on the third page of the I-9 form.
    • You must bring one document from List A; OR
    • One document from List B and one document for List C.


  • MW-507, Employee's Maryland Withholding Exemption Certificate Form

    If you are a Maryland resident:

    • Enter your name, social security number, address and county of residence.
    • Indicate the number of exemptions you are claiming.If you are unsure about the number of exemption to claim, use the Worksheet at the bottom of the form to determine the correction deduction.
    • Sign and date the form.


  • OF-306, Declaration of Federal Employment
    • Provide complete answers and check the boxes that apply to you.
    • Please remember to clarify your responses to questions 8 through 13 and question 17 in the space provided under number 15.
    • If you answer "Yes" to any question from 8 through 12, please immediately telephone the Human Resources Specialist who offered you employment.
    • For number 15, your answer should still be "Yes" if you applied for any of the types of pay listed, but were denied.
    • When you complete this form sign and date after number 17a only.


  • SF-144, Statement of Prior Federal Service
    • This form will be used to allow the US Department of State to verify your pervious federal employment service.
    • In number 5, ensure that you annotate all federal agencies of employment, dates of employment and type of appointment.
    • In number 6, annotate absences, if applicable.
    • In box number 7, annotate military service, dates and type of discharge. Sign and date the form.


  • SF-181, Ethnicity and Race Identification

    Your completion of this form and providing this information is voluntary.Your failure to do so will have no effect on you or your Federal employment. However, if you fail to provide the information, the employing agency will attempt to identify your race and national origin by visual perception.

    • Check the box next to the category that defines your racial and national origin.
    • Mark only one box.


  • SF-256, Self-Identification of Handicap

    Self Identification of handicap status is voluntary. The Privacy Act statement and purpose for handicap data collection is explained on the back of the form.

    • Read through the definitions provided and enter the code of the one which best described your status.
    • Enter only one code.


  • SF-1199A, Direct Deposit Sign-Up Form

    Completion of this form is mandatory for the timely payment of your biweekly salary.

    Section 1

    • A - Enter your name, address, and telephone number.
    • B - Skip
    • C - Enter
    • D - Check next to your account type.
    • E - Enter your account number.Do you leave blank spaces between the numbers.You may use dashes if they are part of your account number.
    • F - Self-explanatory
    • G - Skip

    Joint Account Holders' Certification: If there are two names on the account, both account holders must sign here.

    Section 2

    • Government Agency Name: Department of State
    • Government Agency Address: Washington, DC 20522

    Section 3

    • This must be completed, signed, and dated by your financial institution and given back to you.


  • Unemployment Insurance Benefits
    • Please read, sign and date.


  • VA-4, Virginia Employee's Withholding Exemption Certificate

    If you are a Virginia resident:

    • Enter your social security number, name and address.
    • Indicate the number of withholding exemptions you are claiming.If you are unsure about the number of exemptions to claim, use the Personal Exemption worksheet on the top of the Form VA-4 to determine the correct deduction.
    • Sign and date the form.


  • Voluntary Separation Incentive Payments
    • Check the applicable box, sign and date.


  • W-4, Employee's Withholding Allowance Certificate Form
    • Enter your name, address, and social security number.
    • Indicate the tax rate category and number of exemptions you wish to claim on this Federal income tax withholding form.
    • If you are unsure about the number of exemptions to claim, you can use the Personal Allowances Worksheet at the top of the W-4 form, or, the Deductions and Adjustment Worksheet on the reverse of the form. Additional withholding advice should be sought from a tax professional.
    • Sign and date the form.
Temporary Employees: Optional Benefits Coverage Forms +

Based on your benefits elections, the following forms may be required:

  • SF-1152, Unpaid Compensation Designation of Beneficiary

    Standard rules determine who is eligible to receive these payments. If you are satisfied with the order of payment for that program, you do not have to take any action. But if you want these funds to go to someone else, you need to file a Designation of Beneficiary for that program.

    If you die while you are a Federal employee, payments will be made in the below order as set and dictated by the law as follows:

    • To your widow or widower
    • If none, to your child or children in equal shares, with the share of any deceased child distributed among the child's descendants
    • If none, to your parents in equal shares or the entire amount to your surviving parent>
    • If none, to the executor or administrator of your estate
    • If none, to your next of kin under the laws of the state where you lived at the time of your death

    Please read carefully the specific instructions on each designation form before making your designation.

Transfer Employees: Mandatory Forms +

I am a current federal government employee who is transferring to the DoS from another federal agency.

MANDATORY

  • Department of State Drug Testing Policy
    • Please read, sign and date.


  • D-4, Employee's Withholding Allowance Certificate (DC)

    For residents of the District of Columbia:

    • Enter your name, address, and social security number.
    • Select your filing status and the total number of allowances you are claiming.If you are unsure about the number of allowances to claim, use the Worksheet provided on Form D-4 to determine the correct deduction.
    • Sign and date the form.


  • DS-1031A, U.S. Department of State Biographic Data Sheet
    • Please complete the form annotating all colleges that you attended and list all of your dependents. Sign and date the form.


  • DS-4145, Continued Service Agreement

    Please read, sign and date.

  • DS Locator Sheet
    • Complete the form with the applicable information and date.


  • I-9, Employment Eligibility Verification
    • Complete, sign and date Section 1 only.
    • You must bring two forms of identification with you to orientation. You will be asked to show proof of eligibility for employment in the U.S. You will find a list of acceptable documents on the third page of the I-9 form.
    • You must bring one document from List A; OR
    • One document from List B and one document for List C.


  • Information on Insurance Benefits

    Information regarding the Federal Employees' Group Life Insurance (FEGLI), Federal Employees Health Benefits (FEHB) Program, Federal Long Term Care Insurance Program (FLTCIP).

  • MW-507, Employee's Maryland Withholding Exemption Certificate Form

    If you are a Maryland resident:

    • Enter your name, social security number, address and county of residence.
    • Indicate the number of exemptions you are claiming.If you are unsure about the number of exemption to claim, use the Worksheet at the bottom of the form to determine the correction deduction.
    • Sign and date the form.


  • OF-306, Declaration of Federal Employment
    • Provide complete answers and check the boxes that apply to you.
    • Please remember to clarify your responses to questions 8 through 13 and question 17 in the space provided under number 15.
    • If you answer "Yes" to any question from 8 through 12, please immediately telephone the Human Resources Specialist who offered you employment.
    • For number 15, your answer should still be "Yes" if you applied for any of the types of pay listed, but were denied.
    • When you complete this form sign and date after number 17a only.


  • SF-144, Statement of Prior Federal Service
    • This form will be used to allow the US Department of State to verify your pervious federal employment service.
    • In number 5, ensure that you annotate all federal agencies of employment, dates of employment and type of appointment.
    • In number 6, annotate absences, if applicable.
    • In box number 7, annotate military service, dates and type of discharge. Sign and date the form.


  • SF-181, Ethnicity and Race Identification

    Your completion of this form and providing this information is voluntary.Your failure to do so will have no effect on you or your Federal employment. However, if you fail to provide the information, the employing agency will attempt to identify your race and national origin by visual perception.

    • Check the box next to the category that defines your racial and national origin.
    • Mark only one box.


  • SF-256, Self-Identification of Handicap

    Self Identification of handicap status is voluntary. The Privacy Act statement and purpose for handicap data collection is explained on the back of the form.

    • Read through the definitions provided and enter the code of the one which best described your status.
    • Enter only one code.


  • SF-1199A, Direct Deposit Sign-Up Form

    Completion of this form is mandatory for the timely payment of your biweekly salary.

    Section 1

    • A - Enter your name, address, and telephone number.
    • B - Skip
    • C - Enter
    • D - Check next to your account type.
    • E - Enter your account number.Do you leave blank spaces between the numbers.You may use dashes if they are part of your account number.
    • F - Self-explanatory
    • G - Skip

    Joint Account Holders' Certification: If there are two names on the account, both account holders must sign here.

    Section 2

    • Government Agency Name: Department of State
    • Government Agency Address: Washington, DC 20522

    Section 3

    • This must be completed, signed, and dated by your financial institution and given back to you.


  • Unemployment Insurance Benefits
    • Please read, sign and date.


  • VA-4, Virginia Employee's Withholding Exemption Certificate

    If you are a Virginia resident:

    • Enter your social security number, name and address.
    • Indicate the number of withholding exemptions you are claiming.If you are unsure about the number of exemptions to claim, use the Personal Exemption worksheet on the top of the Form VA-4 to determine the correct deduction.
    • Sign and date the form.


  • Voluntary Separation Incentive Payments
    • Check the applicable box, sign and date.


  • W-4, Employee's Withholding Allowance Certificate Form
    • Enter your name, address, and social security number.
    • Indicate the tax rate category and number of exemptions you wish to claim on this Federal income tax withholding form.
    • If you are unsure about the number of exemptions to claim, you can use the Personal Allowances Worksheet at the top of the W-4 form, or, the Deductions and Adjustment Worksheet on the reverse of the form. Additional withholding advice should be sought from a tax professional.
    • Sign and date the form.
Transfer Employees: Optional Benefits Coverage Forms +

Based on your benefits elections, the following forms may be required:

  • SF-2809, Health Benefits Election Form

    The Federal Employees Health Benefits Program (FEHB) is one of the most valuable benefits of Federal employment, but coverage is not automatic — you must select one of the more than 100 available health plans in order to be covered.

    You have 60 days from your entry on duty date to sign-up for a health insurance plan. If you don't make an election, you are considered to have declined coverage and you must wait until open season to enroll.

    VERY IMPORTANT: Enrollment is not retroactive, and it cannot be made effective the day you enter on duty as you must have been in a pay status during some part of the pay period which precedes the one in which your enrollment becomes effective. Once this requirement has been met your enrollment will become effective on the first day of the first pay period that begins after your employing office receives your enrollment request. Thus the earliest that your health insurance can possibly become effective is the beginning of the pay period that begins after the pay period in which you are hired. You cannot be reimbursed for any medical expenses incurred prior to the effective date. You need to consider this in canceling any other health insurance coverage you may already have, and for scheduling of doctor visits or tests.

    Although you have 60 days to make your election, it is to your advantage to make this election soon in order to be covered in case of accident or illness. There is no retroactive coverage of your expenses prior to the effective date of your coverage. The policy will begin coverage on the effective date, however, and will cover expenses occurring on or after that date, even for conditions occurring before that date. Additional information on all current health plans is available at: http://www.opm.gov/insure/health/index.htm

  • The Federal Long Term Care Insurance Billing Change Form

    Please complete the Personal Information and the Change to Payroll/Annuity Deduction section. Please note: the Department of State's Payroll/Annuity Office Identifier is 19009999. Please sign and date the competed form. When completed, return to the Long Term Care Partner's address annotated on the form.

Limited Non-Career Appointments (Consular Adjudicators, RNs, Social Workers, SPS) +
MANDATORY

All mandatory forms must be sent to your HR Officer prior to your reporting date.

The following forms are required for LNAs:

  • Agreement To Join The Foreign Service

    The Agreement to Join the Foreign Service is the last page of your confirmation letter. Please sign that form and fax it immediately and send the original with the other completed forms.

  • Diplomatic Security: Security Protective Specialists - Conditions of Employment

    Please read, sign and date.

  • DS-1031A, US Department of State Biographic Data Sheet
    • Please complete the form annotating all colleges that you attended and list all of your dependents. Sign and date the form.
  • DS-4237, Continued Service Agreement Limited Non-Career Appointment Hiring Programs

    Please read, sign and date.

  • I-9, Employment Eligibility Verification
    • Complete, sign and date Section 1 only.
    • You must bring two forms of identification with you to orientation. You will be asked to show proof of eligibility for employment in the U.S. You will find a list of acceptable documents on the third page of the I-9 form.
    • You must bring one document from List A; OR
    • One document from List B and one document for List C.

  • Medical Update Form

    Please read, print your name, social security number, date of birth and sign.

  • SF-1152, Unpaid Compensation Designation of Beneficiary

    Standard rules determine who is eligible to receive these payments. If you are satisfied with the order of payment for that program, you do not have to take any action. But if you want these funds to go to someone else, you need to file a Designation of Beneficiary for that program.

    If you die while you are a Federal employee, payments will be made in the below order as set and dictated by the law as follows:

    • To your widow or widower
    • If none, to your child or children in equal shares, with the share of any deceased child distributed among the child's descendants
    • If none, to your parents in equal shares or the entire amount to your surviving parent>
    • If none, to the executor or administrator of your estate
    • If none, to your next of kin under the laws of the state where you lived at the time of your death

    Please read carefully the specific instructions on each designation form before making your designation.

  • SF-1199A, Direct Deposit Sign-Up Form

    Completion of this form is mandatory for the timely payment of your biweekly salary.

    Section 1

    • A - Enter your name, address, and telephone number.
    • B - Skip
    • C - Enter
    • D - Check next to your account type.
    • E - Enter your account number. Do you leave blank spaces between the numbers. You may use dashes if they are part of your account number.
    • F - Self-explanatory
    • G - Skip

    Joint Account Holders' Certification:

    If there are two names on the account, both account holders must sign here.

    Section 2

    • Government Agency Name: Department of State
    • Government Agency Address: Washington, DC 20522

    Section 3 f

    • This must be completed, signed, and dated by your financial institution and given back to you.
  • SF-144, Statement of Prior Federal Service
    • This form will be used to allow the US Department of State to verify your pervious federal employment service.
    • In number 5, ensure that you annotate all federal agencies of employment, dates of employment and type of appointment.
    • In number 6, annotate absences, if applicable.
    • In box number 7, annotate military service, dates and type of discharge. Sign and date the form.
  • SF-181, Ethnicity and Race Identification

    Your completion of this form and providing this information is voluntary.Your failure to do so will have no effect on you or your Federal employment. However, if you fail to provide the information, the employing agency will attempt to identify your race and national origin by visual perception.

    • Check the box next to the category that defines your racial and national origin.
    • Mark only one box.
  • SF-256, Self-Identification of Handicap

    Self Identification of handicap status is voluntary. The Privacy Act statement and purpose for handicap data collection is explained on the back of the form.

    • Read through the definitions provided and enter the code of the one which best described your status.
    • Enter only one code.
  • SF-2809, Health Benefits Election Form

    The Federal Employees Health Benefits Program (FEHB) is one of the most valuable benefits of Federal employment, but coverage is not automatic — you must select one of the more than 100 available health plans in order to be covered.

    You have 60 days from your entry on duty date to sign-up for a health insurance plan. If you don't make an election, you are considered to have declined coverage and you must wait until open season to enroll.

    VERY IMPORTANT: Enrollment is not retroactive, and it cannot be made effective the day you enter on duty as you must have been in a pay status during some part of the pay period which precedes the one in which your enrollment becomes effective. Once this requirement has been met your enrollment will become effective on the first day of the first pay period that begins after your employing office receives your enrollment request. Thus the earliest that your health insurance can possibly become effective is the beginning of the pay period that begins after the pay period in which you are hired. You cannot be reimbursed for any medical expenses incurred prior to the effective date. You need to consider this in canceling any other health insurance coverage you may already have, and for scheduling of doctor visits or tests.

    Although you have 60 days to make your election, it is to your advantage to make this election soon in order to be covered in case of accident or illness. There is no retroactive coverage of your expenses prior to the effective date of your coverage. The policy will begin coverage on the effective date, however, and will cover expenses occurring on or after that date, even for conditions occurring before that date. Additional information on all current health plans is available at: http://www.opm.gov/insure/health/search/plansearch.aspx

  • SF-2817, Life Insurance Election

    If you're in a FEGLI-eligible position, you're automatically enrolled in Basic life insurance, which is effective on the first day you enter in a pay and duty status UNLESS you waive this coverage before the end of your first pay period. You do NOT get any Optional insurance automatically – you have to take action to elect it.

    You have 31 days from your entry date to sign up for any Optional life insurance. If you do not make an election, you are considered to have waived optional insurance.

    No proof of insurability is required for the Basic insurance you get upon being hired or any optional insurance you sign-up for during the first 31 days. Proof of insurability may be required for insurance changes after that time.

  • SF-2823, Life Insurance Designation of Beneficiary

    Standard rules determine who is eligible to receive these payments. If you are satisfied with the order of payment for that program, you do not have to take any action. But if you want these funds to go to someone else, you need to file a Designation of Beneficiary for that program.

    If you die while you are a Federal employee, payments will be made in the below order as set and dictated by the law as follows:

    • To your widow or widower
    • If none, to your child or children in equal shares, with the share of any deceased child distributed among the child's descendants
    • If none, to your parents in equal shares or the entire amount to your surviving parent>
    • If none, to the executor or administrator of your estate
    • If none, to your next of kin under the laws of the state where you lived at the time of your death

    NOTE: If a qualifying court order or an assignment of benefits is on file for the Federal Employees’ Group Life Insurance (FEGLI) Program, the court order or assignment takes precedence over any designation of beneficiary and the above normal order of precedence.

    Please read carefully the specific instructions on each designation form before making your designation.

  • TSP-1, Thrift Savings Plan Election Form (link goes to www.tsp.gov)

    If your appointment confers eligibility for the Federal Employees Retirement System your agency will automatically enroll you in this program.

    Almost all new employees are automatically covered by the Federal Employees Retirement System (FERS). FERS is a three-tiered retirement plan. The three tiers are:

    • Social Security Benefits
    • Basic Benefit Plan
    • Thrift Savings Plan

    You pay full Social Security taxes and a small contribution to the Basic Benefit Plan. In addition, your agency will set up a Thrift Savings Plan account for you and will automatically contribute an amount equal to 1% of your basic pay each pay period. These Agency Automatic (1%) Contributions are not taken out of your salary, and your agency makes these contributions whether or not you contribute your own money to the TSP.

    You are also able to make tax-deferred contributions to the TSP and a portion is matched by the Government. Your agency will invest $1.00 for every $1.00 you invest for the first 3 percent of your basic salary, and 50 cents for each $1.00 you invest for the next 2 percent of your basic salary. The agency contributions are not taken out of your salary; they are an extra benefit to you.

    You can start, change, stop, and resume TSP contributions at any time. There is no waiting period.

    The best way to assure that your retirement income meets your needs is to start investing in the Thrift Savings Plan at the beginning of your Federal service, and to continue to do so throughout your career. It is particularly important for higher-paid employees to save enough through the TSP since Social Security replaces a smaller percentage of the income of higher-paid workers than it does for lower-paid workers. You may contribute up to the maximum annual amount permitted by Internal Revenue Service regulations, currently $16,500 percent of your basic pay.

  • Voluntary Separation Incentive Payments
    • Check the applicable box, sign and date.
  • W-4, Employee's Withholding Allowance Certificate Form
    • Enter your name, address, and social security number.
    • Indicate the tax rate category and number of exemptions you wish to claim on this Federal income tax withholding form.
    • If you are unsure about the number of exemptions to claim, you can use the Personal Allowances Worksheet at the top of the W-4 form, or, the Deductions and Adjustment Worksheet on the reverse of the form. Additional withholding advice should be sought from a tax professional.
    • Sign and date the form.

If you have any questions, please feel free to contact:

Consular Adjudicators

Security Protective Specialists

Best wishes on your Limited Non-Career Appointment.

What Every Employee Needs to Know +
  • The ABCS: What Every Employee Needs to Know

    Download this pdf for information about "Ask Admin", Badges, Child Care, Dress Codes, and more.

  • FastFacts: Insurance Benefits for New/Newly Eligible Federal Employees

    As a new/newly eligible Federal employee, you may be able to enroll in health insurance, dental insurance, vision insurance, flexible spending accounts, life insurance, and/or apply for long term care insurance. Here’s some basic information about each program.

  • Personal Identity Verification (PIV) Applicant Rights and Responsibilities.

    Federal and contractor employees requiring long-term or frequent access to controlled facilities and/or logical access to controlled information must successfully complete a vetting process through an investigation such as a National Agency Check with Inquiries (NACI), or other National Security community investigation to confirm their identity and suitability for physical and logical access.

  • Statement on Discriminatory and Sexual Harassment

    The success of the Department's work to create a more secure, democratic, and prosperous world depends on the collective efforts of its diverse and talented workforce. 

    Discriminatory and sexual harassment erode the morale and the integrity of our workplace, and undermine the activities of the Department. We must all ensure a positive and professional work environment in which all employees can contribute to our mission without fear of harassment. The Department upholds a zero tolerance policy regarding both discriminatory and sexual harassment. All allegations of harassment will be promptly investigated and addressed, and the Department will take immediate action to halt unwelcome behavior should it find that harassment has occurred.

  • Statement on Diversity and Equal Employment Opportunity

    Diversity is one of America's greatest strengths. In representing the United States to the world we need a workforce that reflects and respects the rich composition of our nation. The knowledge, perspectives, ideas, and experiences of all Department of State employees are vital to the success of our global mission. Diversity brings innovation and creativity to the workplace and demonstrates our commitment to inclusion and respect for all people.

  • Your rights as a Federal Employee

    THE U.S. OFFICE OF SPECIAL COUNSEL (OSC) is an independent agency that investigates and prosecutes allegations of prohibited personnel practices (PPP). Learn about PPPs, what an employee can do if a PPP has been committed, the Hatch Act, and contact information for additional information.

  • Prohibited Personnel Practices (PPP)

    Quick reference document of Prohibited Personnel Practices.

  • Whistle Blowing

    The Office of Special Counsel (OSC) provides a secure channel through which current and former federal employees and applicants for federal employment may make confidential disclosures. OSC evaluates the disclosures to determine whether there is a substantial likelihood that one of the categories listed above has been disclosed. If such a determination is made, OSC has the authority to require the head of the agency to investigate the matter.

  • Whistleblower Retaliation

    What Is Whistleblower Retaliation? A federal employee authorized to take, direct others to take, recommend or approve any personnel action may not take, fail to take, or threaten to take any personnel action against an employee because of protected whistleblowing.