Eligible employees must submit a completed RPL registration form to their servicing human resources office on or before the Reduction-in-Force separation date or, if eligible under Title 5, Code of Federal Regulations § 330.203(b), within 30 calendar days after the date of injury compensation benefits cease; or the date the Department of Labor denies an appeal for continuation of injury compensation benefits.
Bureau:___________________ Duty Station City:__________________ State:_____________
Name:___________________________________
Address: Street ____________________________________________________________
City ___________________________ State __________ ZIP Code__________
Telephone #: Home: ________________ Work: ________________ Cell: ____________
Date of RIF Separation: _________________ Tour of Duty: Full-time ______ Other _______
Are you available: For Part-Time Positions? Yes ______ No _______
For Non-Permanent Positions? Yes ______ No _______
Current series and grade/band: ____________Applicable grade/band conversion: ___________________
Current promotion potential: _________________
List the Positions for which you qualify and are available.
(qualification determinations will be made by the servicing human resources office based on the qualification requirements of individual positions)
Title Series Acceptable Grades
Highest Lowest
A. ________________________ _______ _______ __ ______
B. ________________________ _______ _______ __ ______
C. ________________________ _______ _______ __ ______
D. ________________________ _______ _______ __ ______
E. ________________________ _______ _______ __ ______
Note: There is no restriction on the number of positions that can be listed
______________________________________ _______________
Registrant’s Signature Date
_______________________________________________________________________________
For Servicing Human Resources Office Use Only:
Registration Received: ____/____/____ Registrant Added to RPL: _____________
Comments: _____________________________________________________________________
(Include specifics on promotion potential of the position from which separated and any other pertinent information)
HR Point of Contact: _______________________ Telephone: ______________________
Tenure Group:
30% Disabled Veteran: ______ 1 – AD Career _____ 2 – AD Career-Conditional
Veteran: _____ 1– A Career _____ 2 – A Career-Conditional
Non-Veteran: _____ 1– B Career _____ 2 – B Career-Conditional