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Appointment Forms for New Hires United States District Court Michelle Tambellini, Human Resources Manager Nicole Linkes, Human Resources Specialist
Below please find information regarding fingerprinting, background checks, required identification, and benefits as well as appointment forms for your completion. Please review this information carefully, and complete all required forms. The majority of the forms are Adobe Acrobat PDF forms, and should be completed on your p.c. Hand‐written forms are strongly discouraged. We recommend that you save all forms to your p.c. so that you can easily make changes if necessary. Print each form as you complete it, and sign where indicated. Please do not print or submit instruction pages. Please scan and email your completed forms to Michelle or Karen at the email address above. In order to avoid any delay in processing your pay, we ask that you come in for an initial meeting after you've completed your forms and prior to your start date. We will complete any remaining paperwork, verify your ID, complete your fingerprinting, and take your photo for your Court ID card at this time. Please contact us as soon as possible to arrange a date and time for our meeting. If you have any questions, please don't hesitate to contact us. Appointment Forms 1. Application For Judicial Branch Federal Employment (A0‐78)
1. Application For Judicial Branch Federal Employment (A0‐78) 2. Race/Ethnicity, Gender, & Disability Identification You are requested to provide this information to aid the federal judiciary in reporting on equal employment opportunities. This information will be used in planning and monitoring fair employment practices programs. 3. Identification/Employment Eligibility Verification (Form I‐9) 4. Residency Certification Form for Local Earned Income Tax Withholding (CLGS‐32‐6) PA residents working in Pittsburgh should complete the below form: PA residents working in Erie should complete the below form: PA residents working in Johnstown should complete the below form: PA residents working in Duncansville should complete the below form: 5. FastStart Direct Deposit Form (FMS‐2231) 6. Employee's Federal Withholding Allowance Certificate (W4) 7. State Tax Withholding PA Residents: No form is required. Pennsylvania state tax is based on a flat tax rate of 3.07%. There are no allowances based on the number of dependents claimed, marital status, age, etc. 8. Fingerprinting/Background Check 9. Personal Information Form 10. Health Benefits Election Form (SF 2809) http://www.opm.gov/forms/pdf_fill/sf2809.pdf Your option to enroll in a health care plan is limited to 60 days from your start date. The earliest your health benefits can be made effective is the first Monday of the pay period that begins AFTER your start date, and after you submit your enrollment form. Since the judiciary uses biweekly pay periods, it could be up to two weeks before your health benefits are effective, depending on your start date. Once you make your election it can NOT be changed, so please carefully consider your options when making your selection. You will only be able to make changes during the annual Open Season (November to early December) or if you experience a qualifying life event such as marriage or birth of a child. The Federal Employee Health Benefits (FEHB) program offers different types of health plans, including fee-for-service, HMO's, and high deductible plans which offer a Health Savings Account component. Please note that if you enroll in a plan with a Health Savings Account or are covered by a Health Savings account through a family member or otherwise, you are NOT eligible to elect a Health Care Reimbursement Account under the Judiciary's Flexible Benefit Program. An individual is not permitted to have a Health Savings Account and a Health Care Reimbursement Account at the same time. 11. Life Insurance Election Form (SF 2817) Additional information may also be found at: http://www.opm.gov/Forms/pdf_fill/SF2817.pdf Unless you waive coverage, you will be automatically enrolled in the Basic Life Insurance Plan effective on your start date, and deductions will be taken directly from your pay to cover the cost of this plan. You must complete the Life Insurance Election Form to indicate whether you wish to waive coverage, elect basic coverage, or elect optional coverage in addition to basic. You will have 60 days to elect additional Optional coverage. To waive coverage and avoid deductions to your paycheck, complete the Election Form and return to Personnel during your initial meeting or before the end of your first pay period. If you do waive coverage, there is a one year minimum waiting period from the date of the signed waiver, and you must provide satisfactory medical evidence of insurability before re‐enrolling. 12. Designation of Beneficiary Form ‐FEGLI (SF‐2823) (optional) 13. Designation of Beneficiary Form – Unpaid Compensation (SF ‐1152) (optional) 14. Designation of Beneficiary Form - FERS (SF-3102) (optional) (career employees only) 15. Designation of Beneficiary Form - FERS (TSP-3) (optional) (career employees only) Supplemental Benefits Forms for enrolling in the following supplemental benefits are not provided in this document. Instructions for enrolling in supplemental benefits will be provided during your initial meeting with Personnel. Please see the links provided below for additional information. After your start date, you will also receive a packet in the mail directly from the third party administrator of these plans. Note that most of these benefits allow for 60 days to elect. |