Fillable Printable OPM Form 1655-A
Fillable Printable OPM Form 1655-A
OPM Form 1655-A
United States Office of Personnel Management
Form Approved:
OMB No. 3206-0248
Geographic Preference Statement for
Senior Administrative Law Judge Applicant
Instructions: Type or print clearly in black or blue ink. In the boxes below, indicate with an “X” each location where
you would be available to serve as a Senior Administrative Law Judge (SALJ). You may show availability for any
locations listed. You will be considered only for positions where you have indicated your availability. Submit form to:
Human Capital Leadership & Merit System Accountability Division, Administrative Law Judge Program, U.S.
Office of Personnel Management, 1900 E Street, NW, Washington, DC 20415.
Name (Last, First, MI)
Address (Street, City, State, ZIP Code)
All Locations
Check this box only if you are
interested in all locations.
All Locations
Washington, DC, Metro Area
Washingto
n, DC, Metro Area
(Rockville, MD; Arlington, VA;
Falls
Church, VA; Washington,
DC)
Region 1 - Boston
All Region 1
Hartford, CT
New Ha
ven, CT
Boston, MA
Springfield, MA
Portland, ME
Manchester, NH
Providence, RI
Other _______________
Region 2 - New York
All Region 2
Newark, NJ
Voorhees, NJ
Albany, NY
Bronx, NY
Brooklyn, NY
Buffalo, NY
Jericho, NY
New York, NY
Queens, NY
Rochester, NY
Syracuse, NY
White Plains, NY
Mayaquez, PR
Ponce, PR
San Juan, PR
Other _______________
5 U.S.C. § 3323(b)
5 CFR 930.201 et seq
Region 3 - Philadelphia
All Region 3
Dover, DE
Baltimore, MD
Elkins Park, PA
Harrisburg, PA
Johnstown, PA
Philadelphia, PA
Philadelphia (East), PA
Pittsburgh, PA
Wilkes-Barre, PA
Charlottesville, VA
Norfolk, VA
Richmond, VA
Roanoke, VA
Charleston, WV
Huntington, WV
Morgantown, WV
Other _______________
Region 4 - Atlanta
All Region 4
Birmingham, AL
Florence, AL
Mobile, AL
Montgomery, AL
Fort Lauderdale, FL
Jacksonville, FL
Miami, FL
Orlando, FL
Tampa, FL
Atlanta, GA
Atlanta (North), GA
Macon, GA
Savannah, GA
Lexington, KY
Louisville, KY
Middlesboro, KY
Paducah, KY
Hattiesburg, MS
Jackson, MS
Page 1
Region 4 – Atlanta (cont’d.)
Tupelo, MS
Charlotte, NC
Greensboro, NC
Raleigh, NC
Charleston, SC
Columbia, SC
Greenville, SC
Chattanooga, TN
Kingsport, TN
Knoxville, TN
Memphis, TN
Nashville, TN
Other _______________
Region 5 - Chicago
All Region 5
Chicago (South), IL
Evanston, IL
Oakbrook Terrace, IL
Orland Park, IL
Peoria, IL
Evansville, IN
Fort Wayne, IN
Indianapolis, IN
Detroit, MI
Flint, MI
Grand Rapids, MI
Lansing, MI
Oak Park, MI
Minneapolis, MN
Cincinnati, OH
Cleveland, OH
Columbus, OH
Dayton, OH
Madison, WI
Milwaukee, WI
Other _______________
OPM Form 1655-A
January 2008
Form Approved:
United States Office of Personnel Management
OMB No. 3206-0248
Region 6 - Dallas Region 7 - Kansas City (cont’d.) Region 9 - San Francisco
All Region 6
Springfield, MO
(cont’d.)
Fort Smith, AR
St. Louis, MO
Oakland, CA
Little Rock, AR
Omaha, NE
Orange, CA
Alexandria, LA
Other _______________
Pasadena, CA
Metairie, LA Sacramento, CA
New Orleans, LA
Region 8 - Denver
San Bernardino, CA
Shreveport, LA
All Region 8
San Diego, CA
Albuquerque, NM
Denver, CO
San Francisco, CA
McAlester, OK
Billings, MT
San Jose, CA
Oklahoma City, OK
Fargo, ND
San Rafael, CA
Tulsa, OK
Rapid City, SD
Santa Barbara, CA
Dallas (Downtown), TX
Sioux Falls, SD
Stockton, CA
Dallas (North), TX
Salt Lake City, UT
Honolulu, HI
Fort Worth, TX
Other _______________
Las Vegas, NV
Houston, TX Other _______________
Houston (Downtown), TX
Region 9 - San Francisco
San Antonio, TX
All Region 9
Region 10 - Seattle
Other _______________
Phoenix, AZ
All Region 10
Tucson, AZ
Eugene, OR
Region 7 - Kansas City
Downey, CA
Portland, OR
All Region 7
Fresno, CA
Seattle, WA
West Des Moines, IA
Long Beach, CA
Spokane, WA
Kansas City, KS
Los Angeles (Downtown), CA
Other ________
______
Wichita, KS
Los Angeles (West), CA
Creve Coeur, MO
Privacy Act Statement
The information on this form is collected pursuant to 5 U.S.C. § 3323(b) and 5 CFR 930.201 et seq. This completed
form allows us to refer your application to Federal agencies that have SALJ positions where you may want to work. In
addition, this record may be used to develop statistics and studies concerning our SALJ Program. Supplying this
information is voluntary, but if you do not provide it you may lose job opportunities because we may not be able to
properly refer your application.
Public Burden Statement
We estimate the public reporting burden for this collection will vary from 15 to 25 minutes with an average of 10
minutes per response, including time for reviewing instructions, searching existing data sources, gathering data, and
completing and reviewing the information. Send comments regarding the burden estimate or any other aspect of the
collection of information, including suggestions for reducing this burden, to the U.S. Office of Personnel Management
(OPM), OPM Forms Officer, Washington, DC 20415-7900. The OMB number, 3206-0248, is currently valid. OPM
may
not collect this i
nformation and you are not required to respond, unless this number is displayed. Do not send
completed application forms to this address
.
Reasonable Accommodation
Federal agencies must provide reasonable accommodation to applicants with disabilities where appropriate.
Applicants requiring reasonable accommodation for any part of the hiring process should contact the appointing
agency directly. Determinations on requests for reasonable accommodation will be made on a case-by-case basis
.
THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
5 U.S.C. § 3323(b)
Page 2
OPM Form 1655-A
January 2008
5 CFR 930.201 et seq
Date
Signature
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