Sample Application: Add Federal Civilian Employment

Note: You'll begin by searching for your federal employer by entering the name of the agency OR the three-digit Federal Agency Identification Code (from your SF-8) in a search window. From the search results in the window, click the "Select" button in front of the line showing your employer. If you cannot locate your employer by searching, click "Employer Not Found". Continue with the completion of the other items on this page.

Federal civilian employer or agency (box #46 on SF50)

__________________________________

Mailing Address

__________________________________

Additional Address

__________________________________

City

__________________________________

State:

ZIP:

____________ - _________

What was the State or Country of your last official duty station? (Box #39 of Form SF50)

What is your current state of residence?

Do you have your Standard Form 8 (SF8) and/or SF50 form?

Yes No

If you answer "yes", an additional field will appear:
Were you issued an SF8 form?	Yes No

Employment Start Date (mm dd yyyy):

___________ ___________ ___________

Employment End Date (mm dd yyyy):

___________ ___________ ___________

What was your hourly rate of pay?

$__________ . ______

Was your Federal job part time?

Yes No

What was your position title?

_______________________

Estimated Gross Monthly Pay while employed with this employer:

$_________ . _____

Reason no longer employed:

Depending on your reason for separation, an addition field may appear:
Please provide a brief explanation for your separation/reduced hours from work. Your comments will be seen by this employer. You have only 59 characters including spaces available. Don't worry about not being able to tell exactly what happened. You will be mailed a questionnaire and given the opportunity to provide complete and separation information.
Comments:	______________________________________________________

Have you applied for or are you receiving a Pension from this employer?

Yes No

Did you or will you be paid Holiday Pay from this employer for this week?

Yes No

Did you or will you be paid Vacation Pay from this employer for this week?

Yes No

Do you have a definite return to work date with this employer on or before [ date ]?

Note: This is a dynamically calculated date that is the Sunday five weeks from the Sunday date of the week you are filing this claim.

Yes No

A few days after you actually file your application, you will receive a packet in the mail which will include a Claimant's Affidavit of Federal Civilian Service and Reason for Separation (GUES935). It is important you complete this form and mail or fax it to the address that will be provided to you when you file.