Fillable Printable SF 144
Fillable Printable SF 144
SF 144
-
I
STANDARD
FORM
144
(Rev.
10/95)
Office
of
Personnel
Management
The
Guide
to
Processing
Personnel
Actions
Statement of Prior Federal Service
(PLEASE READ
THE
FOLLOWING
INFORMATION BEFORE
COMPLETING
THIS
FORM)
Privacy
Act
Statement
Section 6303
of
5 U.S.C., "Annual Leave Accrual," authorizes col-
lection
of
information
to
determine and record service that may be
creditable for accrual
of
annual leave. Part 351.503, 5 C.F.R.,
"Length
of
Service," authorizes collection
of
data to determine and
record
service that may be creditable for reduction-in-force reten-
tion purposes.
Information about prior Federal civilian and military service
is
col-
lected and maintained
in
your Official Personnel Folder
(OPF).
The
information you furnish may be disclosed to other Federal agencies
or
Congressional
or
Judicial Offices
in
order to verify it
or
in
con-
nection with your application for a job, license, grant, or other ben-
efit. It may also be disclosed to a national, state,
or
local law
enforcement agency where there is indication
of
a violation or
potential violation of civil or criminal law or regulation, or
to
another
Federal agency or court when the
Government
is
party to a suit.
Furnishing this information
is
voluntary; however, failure to
do
so
may result
in
your
not
receiving credit for prior Federal service.
I.
What
Is
Needed
to
Verify
Prior
Service
In
order for your employing agency
to
credit your prior Federal ser-
vice for benefits, such as leave accrual and reduction-in-force reten-
tion, the dates
of
your active uniformed service and the type(s)
of
appointment(s) and dates
of
civilian service must be verified. Dates
of
active uniformed service are verified from the records issued by
the branch
of
service
in
which you served. Dates and types
of
appointments
to
civilian positions are usually verified from Notifi-
cations
of
Personnel Action (Standard Form 50
or
CSC-
or
OPM-
approved exceptions thereto), and payroll records (including records
of
deductions made under the Civil Service Retirement
System-
Standard Form 2806,
or
the Federal Employees Retirement Sys-
tem-Standard
Form 3100). The information on the application or
resume you submitted for the appointment you are receiving, along
with the information on page 2
of
this form, will be used by your
agency to identify the Federal employers and periods
of
employ-
ment for which records must be obtained
to
verify the prior service.
When Notification
of
Personnel Action or payroll records cannot be
located
to
verify a period
of
service, and the service was covered by
Social Security, a detailed statement
of
earnings information (show-
ing periods
of
employment and the name
of
the employer) from the
Social Security Administration will be accepted as proof
of
service.
If no personnel, payroll,
or
Social Security records can be located,
then your agency can accept secondary evidence
of
civilian em-
ployment, as explained below.
II. Use of Secondary Evidence to Verify Federal Service
Secondary evidence may be considered as proof
of
Federal civilian
service only when official
Government records are lost, destroyed,
or
incomplete. Necessarily, the burden of proof
is
on
the person
claiming service that
is
not supported by official records
in
the cus-
tody
of
the U.S. Government. If you decide to claim credit for a peri-
od
of
service by submitting secondary evidence, it
is
important that
you
submit all documents
in
your possession that tend
to
prove
you performed the service claimed, and that the service, if per-
formed, was creditable for
leave accrual and reduction-in-force pur-
poses.
No credit can be allowed for any service that is not sub-
stantiated
by valid and conclusive secondary evidence. The follow-
ing is applicable only if you are providing secondary evidence.
A.
Documentary Evidence: Submit as many as possible
of
the
doc-
uments listed
in
item 1 below. If your agency finds that these
docu-
ments are insufficient to determine creditability, the documents listed
in
items 2 and 3 may be considered, but less weight will be given
to
such evidence.
1.
Copies
of
official documents or letters about the service. These
may be notices on appointment/separation; notices
of
changes
in
position/salary, organization, or headquarters; travel orders;
payroll cards; ID's, etc.
2.
Private records such as a diary, correspondence, copies
of
in-
come tax returns, employment applications, credit applications,
etc., that mention the Federal employer and the claimed service.
Private records must
have been made during or shortly after
period of service.
3.
Any other documentary evidence tending
to
prove the service
was actually performed and the starting and ending dates
of
the service.
B.
Affidavit Evidence: If you are not able to supply copies
of
official
documents
(as
described
in
item 1 above) that are sufficient for your
agency to make a determination
of
creditability, you must submit affi-
davits from yourself and at least
two
other persons (preferably your
supervisors) who know the facts. If you can obtain no documentary
evidence (items
1,
2,
and
3,
above) to support your claim, you may
submit these affidavits only;
however, your claim
is
more likely
to
be
rejected without supporting documents. The required affidavits are
from:
-The
employee, stating as many
of
the details on the affidavit as
can accurately be remembered.
-At
least
two
persons knowing the facts. Each person should
show that
he
or
she
is
in
a position to know the facts sworn to,
and
give his or her age and mailing address.
Affidavits must be sworn to or affirmed before a notary public or
other officer who
is
authorized by law to administer oaths.
C.
Warning: Any submission may be investigated. Intentional false
statements, willful concealments,
or
using documents you know are
false, fictitious,
or
fraudulent
is
punishable by fine/imprisonment
(18
U.S.C.1001).
144-114
NSN
7540-00-634-4101
Previous Edition Usable
Standard Form 144
(Rev.
10/95) Page 2
Office
of
Personnel
Management
The Guide
to
Processing Personnel
Actions
STATEMENT OF PRIOR FEDERAL SERVICE
To
be
Completed by Employee
1.
Name
(Last, First,
Middle
Initial) 2.
Social
Security
Number
3.
Date
of
Birth
(Month,
Day, Year)
4.
Does
the
application
or
resume
that
you
submitted,
for
the
position
to
which
you
are
being
appointed,
list
all
of
your
Federal
government
civilian
and
uniformed
service,
including
beginning
and
ending
dates,
as
well
as
the
type
of
apPOintment
and
work
schedule
for
civilian
service?
c::J
Yes - If "Yes",
check
this
block
and
skip
to
Item
8. c::J
No
- If
"No",
check
this
block
and
complete
Items
5 - 9.
5.
List
below
your
prior
civilian
service.
Include
service
with
the
DC
Government
on
appointments
made
before
October
1,
1987.
FROM
TO
TYPE
OF
APPOINTMENT
NAME
AND
LOCATION OF
AGENCY
AND
WORK
SCHEDULE
Year
Month
Day
Year
Month
Day
(Full-Time, Part-Time,
or
Intermittent)
I
6.
During
periods
of
employment
shown
in
Item
5,
did
you
have
a
total
of
more
than
6
months'
absence
without
pay
during
anyone
calendar
year?
c::J Yes - If "Yes",
list
the
following
information.
c::J
No
- If
"No",
go
to
Item
7.
TYPE
OF
ABSENCE,
IF
KNOWN
FROM
TO
TOTAL
(LWOP,
Furlough,
Suspension,
AWOL,
or
Placement
in
Nonpay
Status)
Year
Month
Day
Year
Month
Day
YEARS
MONTHS
DAYS
7.
List
all
uniformed
service
below.
List
active
service
in
any
branch
of
the
Armed
Forces
of
the
United
States,
including
active
duty
as
a
reservist, and
active
service
in
the
commissioned
corps
of
the
Public
Health
Service
or
the
National
Oceanic
and
Atmospheric
Administration.
FROM
TO
BRANCH
OF
SERVICE
DISCHARGE
Year
Month
Day
Year
Month
Day
(Honorable
or
Dishonorable)
8. Do
you
claim
any
type
of
veterans'
preference
which
has
not
been
verified?
c::J
No
c::J
Yes -
Check
one
of
the
statements,
if it
applies
to
you.
I
claim
preference
as
the:
c::J
C=:J
c::J
Spouse
of
a
disabled
veteran
Mother
of
a
deceased
or
disabled
veteran
Unmarried
widow/widower
of
a veteran
9.
CERTIFICATION:
The
prior
Federal civilian
and
uniformed
service
listed
on
my
application/resume
and
listed
above
constitutes
my
entire
record
of
Federal
employment.
I
have
no
other
Federal
service
for
which
I
want
to
claim
credit.
Signature
Date
NSN
7540-00-634-4101
Previous
Edition
Usable
144-114
·U.S. Government Printing Office:
1996·
404·761/32401
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