Form FR-28 Application for Employment with the Board of Governors o

Board of Governors
of the Federal Reserve System
Washington, DC 20551

Application for Employment

OMB No. 7100-0181
Average hours per response: 1
Approval Expires October 31, 2017

An equal opportunity employer

Please type or print

Background
Position for Which Application is Made

Date of Application

Date Available

Full Name
First

Middle

Last

Previous, If Any

Address
Number and Street

City

State

ZIP Code

E-mail Address
Telephone (Include Area Code)
Home

Office

Are you a United States citizen?

Yes

Cell

No

How did you learn about this position?

Education and Training*

Name and Complete Address of Schools Attended

From

To

Mo. Yr.

Mo. Yr.

Graduate Year
GradYes No uated

Type
of
Degree

Major Subjects

Minor Subjects

High School

College—Attendance or degrees from accredited schools

Graduate School—Attendance or degrees from
accredited schools

Technical/Other Training Schools

*Note: Provide an explanation for incomplete schooling or training.
Titles of Publication(s), Thesis, etc.

Professional Licenses and Memberships

Typing Speed Computer Skills/Other Training or Skills
wpm
The Federal Reserve may not conduct or sponsor, and an organization (or a person) is not required to
respond to, a collection of information unless it displays a currently valid OMB control number.

FR 28
07/2015

Employment Record
Please list all employment. If you were employed under a different name than shown on page one,please indicate.
Current Employment (Month & Year)

Title of Position

From

Classification Grade
(If in Federal Service)

To

Salary or Earnings
Start

Current

Base
Immediate Supervisor

Name and Address of Employer

Supplemental (Itemize)

Name
Telephone
May we contact
this person?

Yes

No

Reason for Desiring to Change Employment

Date of Last Promotion

Number of Hours Worked Per Week
Amount of Increase

Date of Last Salary Increase

Brief Description of Duties and Responsibilities

Previous Employment (Month & Year)

Title of Position

From
To
Name and Address of Employer

Classification Grade
Salary or Earnings Start
(If in Federal Service)
Base
Supplemental

May we contact
this person?

Immediate Supervisor
Name

No

Yes

Telephone
Reason for Desiring to Change Employment

End

Number of Hours Worked Per Week

Brief Description of Duties and Responsibilities

Previous Employment (Month & Year)

Title of Position

From

Classification Grade
(If in Federal Service)

To
Name and Address of Employer

Immediate Supervisor
Name
Telephone

Reason for Desiring to Change Employment

Salary or Earnings
Base
Supplemental

Start

End

May we contact
this person?
Yes

No

Number of Hours Worked Per Week

Brief Description of Duties and Responsibilities

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07/2015

Previous Employment (Month & Year)
From
To

Title of Position

Classification Grade
(If in Federal Service)

Salary or Earnings
Base
Supplemental

Start

May we contact
this person?

Immediate Supervisor

Name and Address of Employer

Name
Telephone
Reason for Desiring to Change Employment

End

No

Yes
Number of Hours Worked Per Week

Brief Description of Duties and Responsibilities

Previous Employment (Month & Year)
From
To

Title of Position

Classification Grade
(If in Federal Service)

Salary or Earnings
Base
Supplemental

Start

May we contact
this person?

Immediate Supervisor

Name and Address of Employer

End

Name

No

Yes

Telephone

Number of Hours Worked Per Week

Reason for Desiring to Change Employment
Brief Description of Duties and Responsibilities

Previous Employment (Month & Year)
From
To

Title of Position

Name and Address of Employer

Classification Grade
(If in Federal Service)

Immediate Supervisor
Name
Telephone

Reason for Desiring to Change Employment

Salary or Earnings
Base
Supplemental

Start

End

May we contact
this person?
Yes

No

Number of Hours Worked Per Week

Brief Description of Duties and Responsibilities

If there are any gaps in your employment record, please explain below.

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07/2015

References
List three persons who are not related to you and who have definite knowledge of your ability to perform the duties of the position for which you are
applying. Do not repeat the names of supervisors listed under “Employment Record.”
Name

Telephone
(Include Area Code)

Address
(Include ZIP Code)

Title or Occupation

General (If you answer Yes to any of these questions, explain fully in the Remarks section. A Yes response to any one of these questions may have an
effect on whether the Board hires you based upon federal law, regulations, and the Board’s policies. Please give the question number in your explanation.)
Yes
No
1. During the last 7 years, have you ever been convicted of a crime, imprisoned, on probation, or on parole? (You must include felonies,
firearms or explosives violations, military court-martials, misdemeanors, and any other matter that was resolved by a plea of nolo
contendere (no contest). However (you may omit: [a] minor traffic violations that resulted in a fine of $300 or less; [b] any offense
committed before your 16th birthday; [c] any offense committed before your 18th birthday that was finally adjudicated in a juvenile
court or under a youth offender law; and [d] any conviction in which the record has been expunged under federal or state law or set
aside under the Federal Youth Corrections Act or similar state law.) Note: A criminal conviction is not an absolute bar to employment
but will be considered in relation to specific job requirements.
2.� Are you now under charges, on trial, or awaiting trial on criminal charges for any violation of law (such as a misdemeanor or a felony)?
3.� Are you delinquent on any federal debt (e.g., federal taxes, loans, overpayment of benefits, defaults on guaranteed or insured loans)?
4.� Have you ever been discharged or asked to resign from any position, or have you resigned after having been informed that
your employer intended to discharge you?
5. Do you receive any annuity from the United States or District of Columbia governments under any retirement act or any pension
or compensation for military service?
6. Are you related to or acquainted with any employee of the Board of Governors of the Federal Reserve System?
7. Are you related to any officer or director of a financial and/or banking institution?
8. Do you, your spouse, or your minor children own debt (bonds) or equity (stock) of a bank, thrift, or other depository institution or its
affiliates, or of a primary government securities dealer or its affiliates?
9. Are you willing to travel in connection with your duties? (Yes response does not require an explanation.)

Remarks

(Attach any other information you feel reflects your qualifications for the position for which you are applying.)

Notes
College graduates: a copy of your college transcript is requested prior to
employment. Male applicants born after December 31, 1959, must be
registered with the Selective Service System or have a valid exemption
in order to be eligible for Board employment. You will be required to
certify your status at the time of employment.
A background security investigation will be required for all new hires.
Appointment will be subject to the applicant’s successful completion of a
background security investigation and favorable adjudication. Failure to
successfully meet these requirements will be grounds for termination.
Some persons employed by the Board must satisfactorily complete a
physical examination and may be subject to drug testing.
Persons employed by the Board are required to provide information
showing their legal entitlement to work in the United States.
All positions at the Board are appointed without regard to the provisions
of the classified civil service except politically appointed positions.
Applications are retained in our active file for one year. Applicants who
wish consideration beyond this time must reapply.
Those employed by the Board must abide by the Standards of Ethical
Conduct for Employees of the Executive Branch.
Disclosure of previous names used by an applicant after the applicant
has reached the legal age of employment is necessary to confirm an
applicant’s employment record.
For information on alternative formats or questions for persons with
disabilities, or if you need assistance completing the application because
of a disability, contact the Board’s Human Resources Function,
Recruiting Office at 202-452-3880, TDD (Telecommunications Device for
the Deaf) 202-872-4984.

The Board of Governors of the Federal Reserve System has:
1. Adopted regulations and procedures to assure equal opportunity in
employment for all persons; to prohibit discrimination in employment
because of race, religion, color, national origin, sex, physical or mental
disability, or age; and to promote the full realization of equal employment
through a positive continuing program in every aspect of Board
personnel policy and practice. An aggrieved applicant for employment
who believes that he or she has been discriminated against because of
race, religion, color, national origin, sex, disability, or age should consult
with an EEO Counselor within 45 days of the date of the event he or she
believes was discriminatory. A list of EEO Counselors can be obtained
from the Division of Human Resources Management.
2. Rules regarding financial interests of employees that restrict ownership
by employees, their spouses, and their minor children of debt (bonds) or
equity (stock) of banks, thrifts, and other depository institutions or their
affiliates and of primary government securities dealers or their affiliates.
Questions should be directed to the Ethics Officer in the Board’s Legal
Division.
I certify that, to the best of my knowledge and belief, all of the information
on and attached to this application is true, correct, and complete and made
in good faith. I consent to the release of information about my ability and
fitness for Board employment by employers, schools, law enforcement
agencies and other individuals and organizations, to investigators,
personnel staffing specialists, and other authorized employees of the
federal government. I understand that false or fraudulent information on or
attached to this application may be grounds for not hiring me or for firing me
after I begin work, and may be punishable by fine or imprisonment. I
understand that any information I give may be investigated. I have read and
understand the Privacy Act Statement issued by the Board pursuant to the
Privacy Act of 1974 and provided to me in connection with the application.
Applicant’s Signature

PAPER REDUCTION ACT NOTICE
This application for employment is authorized by law [12 U.S.C. §§ 244 and 248(1)].
Public reporting burden for this employment application is estimated to average one hour per
response, including the time to gather the information in the required form and to review
instructions and complete the application.

FR 28

Send comments regarding this burden estimate or any other aspect of this employ -ment
application, including suggestions for reducing this burden, to Secretary, Board of Governors of the
Federal Reserve System, 20th and C Streets, NW, Washington, DC 20551; and to the Office of
Management and Budget, Paperwork Reduction Project (7100-0181), Washington, DC 20503.

07/2015