You are here

New Employee Information

Appointment Forms for New Hires United States District Court
for the Western District of Pennsylvania
Joseph F. Weis, Jr.
U.S. Courthouse
700 Grant Street
Pittsburgh, PA 15219

Michelle Tambellini, Human Resources Manager
Michelle_Tambellini@pawd.uscourts.gov
(412) 208-7536

Nicole Linkes, Human Resources Specialist
Nicole_Linkes@pawd.uscourts.gov
(412) 208-7537

 

Please review this information carefully, and complete all required forms.  Hand‐written forms are strongly discouraged. Please provide completed forms electronically to pawdml_human_resources@pawd.uscourts.gov. If you have any questions, please don't hesitate to contact us.

Appointment Forms
Below you will find links to various appointment forms for your completion. Unless designated as “optional” in the description provided, all forms are required to be completed to begin your employment with the court. Detailed instructions are included on how to complete each form.

1. Application For Judicial Branch Federal Employment (A0‐78)
2. Race/Ethnicity, Gender, & Disability Identification
3. Identification/Employment Eligibility Verification (Form I‐9)
4. Residency Certification Form for Local Earned Income Tax Withholding (CLGS‐32‐6)
5. FastStart Direct Deposit Form (FMS‐2231)
6. Employee's Federal Withholding Allowance Certificate (W4)
7. State Tax Withholding
8. Fingerprinting/Background Check
9. Personal Information Form
10. Health Benefits Election Form (SF 2809)
11. Life Insurance Election Form (SF 2817)
12. Designation of Beneficiary Form ‐FEGLI (SF‐2823)
13. Designation of Beneficiary Form – Unpaid Compensation (SF ‐1152)
14. Designation of Beneficiary Form - FERS (SF-3102)
15. Designation of Beneficiary Form - FERS (TSP-3)

 

1. Application For Judicial Branch Federal Employment (A0‐78)
http://www.uscourts.gov/uscourts/FormsAndFees/Forms/AO078.pdf
Complete this form accurately and entirely, as it is an important record of prior experience used to determine your qualifications and may be used in future consideration of opportunities for advancement. Current address should be the address you will be residing at during your employment. Under the Work Experience section, begin with your most recent position and work back in time. Be sure to include the month‐day‐year of employment and number of hours worked per week. Also include all legal experience (paid, unpaid or as a volunteer) after obtaining your JD, and we must have your exact date of receiving JD (month-day-year).

2. Race/Ethnicity, Gender, & Disability Identification
Voluntary Identification Form

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)
https://www.uscis.gov/sites/default/files/document/forms/i-9.pdf
Form I‐9 has been provided to you in order to verify your eligibility for employment with the U.S. Courts. Please complete Section 1 of this form. You are required to present proper identification. Please review the Lists of Acceptable Documents on the last page of the Employment Eligibility (I‐9) Form for accepted forms of identification. Your identification must be current; expired identification will not be accepted. Please note that you must provide either one form of identification from List A or two forms of identification: one from List B and another from List C.

4. Residency Certification Form for Local Earned Income Tax Withholding (CLGS‐32‐6)
This form is required for all employees who will be working in Pennsylvania. Complete one of the below forms based on where you live and where you will be working. Please leave the gray areas blank. Complete the Employee Information and Certification sections.

PA residents working in Pittsburgh should complete the below form:
Res Cert Pittsburgh

PA residents working in Erie should complete the below form:
Res Cert Erie

PA residents working in Johnstown should complete the below form:
Res Cert Johnstown

PA residents working in Duncansville should complete the below form:
Res Cert Duncansville

5. FastStart Direct Deposit Form (FMS‐2231)
https://www.fiscal.treasury.gov/fsservices/gov/pmt/eft/2231.pdf
Direct Deposit is mandatory for all government employees. Follow the instructions provided on page two of the form. The last digit of your Routing Transit Number goes in the “Check Digit” field. Please enter your Social Security Number in the “Employee Payroll Identification Number” space. Consult your bank if you need assistance completing this form.

6. Employee's Federal Withholding Allowance Certificate (W4)
http://www.irs.gov/pub/irs-pdf/fw4.pdf
*IMPORTANT NOTE* The address entered on the W‐4 is the “address of record” used for mailing the W‐2 at the end of the year and for other benefit mailing purposes. If an out of state address is listed on this form, withholdings for that state may apply (in addition to PA withholdings). Complete the first page of this form to withhold the correct amount of federal income tax from your pay. Please complete the worksheet or consult an accountant or tax preparer for advice on the number of allowances you should claim.

7. State Tax Withholding
You will have PA Income Tax withheld from your pay.

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 (Not required at this time)/Background Check
Finger printing Document 
http://www.uscourts.gov/HR/Background_Check_FAQs.pdf
Please note that as a condition of employment, a background check, including fingerprinting, is now mandatory for all new employees who are appointed to positions in the federal courts. Please complete the above Fingerprint Information Sheet. The information collected on this form is required to be forwarded with your fingerprints for purposes of requesting your background check. You will be hired provisionally, pending the outcome of the background check. A link to frequently asked questions regarding background checks is also included above.

9. Personal Information Form
COOPinfosheet.pdf 
The information requested in this form is for use in an emergency situation.

10. Health Benefits Election Form (SF 2809)
To view available plans, please visit the Office of Personnel Management (OPM) website. This site offers reference materials and a comparison tool to assist employees with choosing a health plan that best meets their needs.

https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plans/2022/state/pa (link is external)
http://www.opm.gov/forms/pdf_fill/sf2809.pdf (link is external)

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 your enrollment is processed through the Administrative Office.  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.  Additional information will be provided by HR during your first week of employment.

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)
For information on the life insurance program, please review the attached brochure.
http://www.opm.gov/healthcare-insurance/life-insurance/reference-materials/federalbooklet.pdf (link is external)

Additional information may also be found at:
http://www.opm.gov/healthcare-insurance/life-insurance/
http://www.opm.gov/Forms/pdf_fill/SF2817.pdf

Employees are automatically enrolled in Basic Life Insurance which is effective on the first day. However, during the first week of employment, employees may opt out. Additional information will be provided by HR during the first week of employment.

Information on Federal Employees' Group Life Insurance (FEGLI) is available at http://www.opm.gov/healthcare‐insurance/life‐insurance  (link is external). To determine the value of your coverage and calculate premiums, visit the FEGLI Calculator (link is external).

You will have 60 days to elect additional Optional coverage. If you wish to cancel coverage, information will be provided during your first week of employment. If you do cancel coverage, there is a one year minimum waiting period from the date of cancellation.

12. Designation of Beneficiary Form ‐FEGLI (SF‐2823) (optional)
http://www.opm.gov/forms/pdf_fill/sf2823.pdf
If you elect life insurance coverage, please complete a Designation of Beneficiary Form (SF‐2823). Two witnesses are required. Forms may not contain corrections of any kind (scratch outs, whiteout, etc).

13. Designation of Beneficiary Form – Unpaid Compensation (SF ‐1152) (optional)
http://www.opm.gov/forms/pdf_fill/SF1152.pdf
For completion by all employees. Beneficiaries receive monies not yet received by the employee, such as unpaid salary and lump sum annual leave payments. Please enter your name and home address in the box at the bottom of the form. Two witnesses are required. Forms may not contain corrections of any kind (scratch outs, whiteout, etc).

14. Designation of Beneficiary Form - FERS (SF-3102) (optional) (career employees only)
http://jnet.ao.dcn/resources/forms/designation-beneficiary-fers
For completion for career employees only. This form is used to designate the beneficiary(ies) for any Federal Employees Retirement System (FERS) lump-sum benefits payments. If designation of beneficiary forms are not completed and on file, benefits are paid according to the order of precedence which is listed on the form, unless there is a court order in effect that would require payment to another person(sTwo witnesses are required. Forms may not contain corrections of any kind (scratch outs, whiteout, etc).

15. Designation of Beneficiary Form - FERS (TSP-3) (optional) (career employees only)
https://www.tsp.gov/forms/civilianForms.html
For completion for career employees only. This form is used to designate the beneficiary(ies) for any Thrift Savings Plan (TSP) benefits payments. If designation of beneficiary forms are not completed and on file, benefits are paid according to the order of precedence which is listed on the form, unless there is a court order in effect that would require payment to another person(s) One witness is required. Forms may not contain corrections of any kind (scratch outs, whiteout, etc).

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.