Entry On Duty

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

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 U.S. Department of State.

* 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.

The following forms are required for New Civil Service Employees:

    1. DS-7663, Department of State Drug Testing Policy Please read, sign and date.
    2. 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.

 

    1. DS-7666, DS Locator Sheet Complete the form with the applicable information and date.
    2. 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.
    3. DS-4145, Continued Service Agreement

      Please read, sign and date.

 

    1. 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.
      • You must bring one photocopy of each presented I-9 document for the Department to retain with your personnel records.

       

      Please be advised that the Department utilizes E-Verify to compare information from the Form I-9 to data from U.S. Department of Homeland Security and Social Security Administration records to confirm employment eligibility. The Department reserves the right to terminate employment if your HR Service Provider is unable to confirm your eligibility to work in the United States.

    2. 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).
    3. 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.

 

    1. 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.

 

    1. 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.

 

    1. 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.

 

    1. SF-256, Self-Identification of Disability

      Self Identification of disability status is voluntary. The Privacy Act statement and purpose for disability 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.

 

    1. 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.

 

    1. DS-7665 Unemployment Insurance BenefitsPlease read, sign and date.
    2. 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.

 

  1. DS-7664, Voluntary Separation Incentive Payments Check the applicable box, sign and date.
  2. 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.

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 FormContribution Types:Regular employee contributions— If you’re a Federal Employees’ Retirement System (FERS) employee hired on or after October 1, 2020, your agency has automatically enrolled you in the TSP and 5% of your basic salary is deducted each pay period and deposited in the traditional balance of your TSP account. If you began federal service between August 1, 2010 and September 30, 2020, you were automatically enrolled at 3%.Agency/Service Automatic (1%) Contributions—equal to 1% of your basic pay—are deposited into your TSP account every pay period, beginning the first time you’re paid. (Exception: BRS members do not receive these contributions until they have served 60 days.) Agency/Service Automatic (1%) Contributions are not taken out of your pay; your agency/service gives them to you. You don’t have to contribute any money to your TSP account to receive these contributions, but they are subject to “vesting”.Being vested means that you’re entitled to keep your Agency/Service Automatic (1%) Contributions (and their earnings) after you work in the federal government or uniformed services for a certain number of years. All years of service in a position eligible for the TSP count toward vesting, even if you don’t contribute to the TSP during that time.

    Agency/Service matching contributions—If you’re a FERS or BRS participant, you will receive Agency/Service Matching Contributions from your agency or service based on your regular employee contributions once you’re eligible. Unlike Agency/Service Automatic (1%) Contributions, Matching Contributions are not subject to vesting requirements.

    As a FERS or BRS participant, you receive matching contributions on the first 5% of pay that you contribute each pay period.

    Contributions toward the catch-up limit—Starting in the year you turn 50, you become eligible to save even more by contributing toward the catch-up limit.

    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. Please visit the TSP Contribution Limits page to learn more about current year TSP contribution caps.

  9. TSP-3, Thrift Savings Plan Designation of BeneficiaryYou should designate a person or persons, your estate, or a trust to receive your TSP account after your death. To designate a beneficiary or beneficiaries, log in to My Account on tsp.gov or use one of the ThriftLine options. For us to honor it, your beneficiary designation must be on file with us at the time of your death. We cannot honor a will or any other document.By law, we must pay your properly designated beneficiary(ies) under all circumstances. For example, if you designate your spouse as a beneficiary, a beneficiary participant account will be set up for that spouse after your death, even if you are separated. If you divorce (and even remarry) but do not make a new beneficiary designation, your TSP account will be paid to the individual designated on your record, even if this person has given up all rights to your TSP account. Consequently, if your life situation changes, you may want to make a new beneficiary designation that changes your current one.If you die with a balance in your TSP account and did not designate beneficiaries for that account, the account will be distributed according to the following order of precedence required by law:
    1. To your spouse
    2. If none, to your child or children equally, with the share due any deceased child divided equally among that child’s descendants
    3. If none, to your parents equally or to your surviving parent
    4. If none, to the appointed executor or administrator of your estate
    5. If none, to your next of kin who is entitled to your estate under the laws of the state in which you resided at the time of your death

    As used here, “child” means either a biological child or a child adopted by the participant. It does not include your stepchild unless you have adopted the child. Nor does it include your biological child if that child has been adopted by someone other than your spouse.

    “Parents” does not include stepparents who have not adopted you.

    See the TSP booklet Death Benefits for more information.

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

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 AgreementPlease 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 PolicyPlease 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.
    • You must bring one photocopy of each presented I-9 document for the Department to retain with your personnel records.

     

    Please be advised that the Department utilizes E-Verify to compare information from the Form I-9 to data from U.S. Department of Homeland Security and Social Security Administration records to confirm employment eligibility. The Department reserves the right to terminate employment if your HR Service Provider is unable to confirm your eligibility to work in the United States.

  • DS-4147, Final Confirmation of Medical Clearance Status and Availability for Entry into the Foreign Service Please read, print your name, social security number, date of birth and sign.
  • 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-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

    • 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 Disability

    Self Identification of disability status is voluntary. The Privacy Act statement and purpose for disability 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.

  • DS-7664, 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.

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.

 

 

    • 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.

 

  • TSP-3, Thrift Savings Plan Designation of BeneficiaryStandard 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-7665, Unemployment Insurance BenefitsPlease 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.

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

 

    • 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.

 

 

 

    • 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 Disability

      Self Identification of disability status is voluntary. The Privacy Act statement and purpose for disability 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 FormCompletion 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.

 

 

    • 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.

 

 

  • 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.

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

  • SF-1152, Unpaid Compensation Designation of BeneficiaryStandard 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.

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

MANDATORY

  • DS-7663, 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-7666, 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 BenefitsInformation 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 FormIf 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 IdentificationYour 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 DisabilitySelf Identification of disability status is voluntary. The Privacy Act statement and purpose for disability 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 FormCompletion 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.
  • DS-7665, Unemployment Insurance Benefits
    • Please read, sign and date.
  • VA-4, Virginia Employee’s Withholding Exemption CertificateIf 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.
  • DS-7664, 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.

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 FormPlease 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.
MANDATORY

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

The following forms are required for LNAs:

 

  • DS-4147, Final Confirmation of Medical Clearance Status and Availability for Entry into the Foreign ServicePlease read, print your name, social security number, date of birth and sign.
  • SF-1152, Unpaid Compensation Designation of BeneficiaryStandard 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 FormCompletion 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 IdentificationYour 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 DisabilitySelf Identification of disability status is voluntary. The Privacy Act statement and purpose for disability 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 FormThe 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 ElectionIf 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 BeneficiaryStandard 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.

  • DS-7664, 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.
  • The ABCS: What Every Employee Needs to KnowDownload this pdf for information about “Ask Admin”, Badges, Child Care, Dress Codes, and more.
  • FastFacts: Insurance Benefits for New/Newly Eligible Federal EmployeesAs 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 OpportunityDiversity 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 EmployeeTHE 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 BlowingThe 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 RetaliationWhat 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.

The Voluntary Leave Bank Program (VLBP) is a shared leave program with a pooled fund of annual and restored leave. Under this program a U.S. Direct-hire Foreign Service or Civil Service employee may contribute unused accrued annual leave for use by a leave bank member who is experiencing a personal or family medical emergency and has exhausted his or her available paid leave. The Department of State’s leave bank board operates the leave bank and determines how much donated annual leave an employee may receive from the leave bank. Any unused donated annual leave is returned to the leave bank.

To become a leave bank member, an employee will contribute a minimum amount of annual leave (4, 6, or 8 based on the years of service) to the leave bank annually. Once an employee is enrolled, reenrollment is automatic at the beginning of each leave year. An employee can enroll to become a leave bank member within 60 days of appointment to the agency or return from extended absence, or during annual open enrollment periods. Membership enrollment is done through the Department of State’s intranet site at HR Online, GEMS Employee Self Service.