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     Congratulations on your employment with the United States District Court, Middle District of Pennsylvania!  As a new employee, you are required to complete various forms prior to your hire date. This site contains all of the forms required to process your appointment. 
     All appointment and payroll forms must be completed and returned to the Human Resources Office via email and U.S. Mail, or other carrier no later than four weeks prior to your hire date to ensure timely processing of your appointment. As part of this process, all law clerks must be sworn in by his/her respective Judge. Also, it is recommended that you be sworn in prior to your hire date. Please contact Chambers to arrange a convenient time. 
     If you have any questions on any of the forms, benefits or policies, please contact Human Resources Director Deborah T. Skopek at (570) 207-5670. Thank you.


Return no later than 4 weeks prior to your hire date.
Federal Judicial Branch Application for Employment (AO 78) - include month/day/year for all date entries.
Voluntary Race/Ethnicity, Gender & Disability Identification (AO 78B)
Employment Eligibility Verification Form I-9 (Fillable PDF version right-click and select Save Link As... from the pop-up menu) or a non-fillable version here — proper identification is required (see Page 4 of form)
Emergency Contact Form
FastStart Direct Deposit Form (FMS 2231)
W-4 Federal Withholding Form
Residency Certification Form (complete form for city where you will be working: Scranton, Harrisburg, Williamsport or Wilkes-Barre)
Please see Policies & Procedures Section for additional forms that also need to be returned.


You have sixty (60) days from your hire date to enroll in any or all of the benefits offered by the Federal Judiciary. Please refer to the Benefits Synopsis for an overview of these benefits. Additional information is included below to assist you in making an informed decision.
Term Law Clerk Benefits  
Benefits Overview Brochure  
HEALTH INSURANCE:   Enroll by completing the election forms below  

Health, Dental and Vision Insurance Plans Offered

Scranton | Harrisburg and Williamsport

HMO Plans / Premiums
Health Insurance Information Fee-For-Service Plans / Premiums
  Health Insurance Comparison Tool
Health Insurance Marketplace (Affordable Care Act) Election Form (SF 2809) - Complete Pages 17 and 18
  Important: Proof of family member eligibility must accompany your health benefits election form (SF 2809). The attached file lists documents that may be used to establish family member eligibility. 
LIFE INSURANCE:   Enroll by completing election forms below  
Life Insurance Brochure | Rates effective 10/11/2021 Election Form (SF 2817) - Complete Page 1 only
Premium Calculator Beneficiary Form (SF 2823)
Dental and Vision Summary  
Dental Plan Information Enroll via BENEFEDS (Employing Agency is Federal Judiciary.)
Dental Rates Dental Rating Area
  Dental Comparison Tool
Vision Plan Information Enroll via BENEFEDS (Employing Agency is Federal Judiciary.)
Vision Rates Vision Comparison Tool
Information on the Flexible Benefits Program and the Commuter Benefit will be mailed to your home address from the Federal Judiciary’s Benefits Center. The Long Term Care Insurance information will be mailed from CNA.
Flexible Benefits Program Enroll via Judiciary Benefits Center
Health Care Reimbursement  
Limited Purpose Health Care Reimbursement Account  
Dependent Care Reimbursement  
Premium Payment Plan  
Commuter Benefit Enroll via Judiciary Benefits Center
Long Term Care Insurance Enroll via Long Term Care Partners / John Hancock
  The LTC Insurance is suspended until December 2024.
Parking Subsidy Program

Parking Subsidy Program Enrollment Agreement and Certification*
*If interested in participating in this parking program, please return the Enrollment Agreement directly to Ruth Davies via email. Ruth can be reached at (570) 207-5666.

Employee Assistance Program (EAP)  
Transportation Subsidy Program  


Unpaid Compensation (SF 1152) - Complete Page 1 only


Acknowledgment Form (review, sign, and return)
Your Employee Rights and How to Report Wrongful Conduct: EDR Plan
Code of Conduct for Judicial Employees | Ethics for Chambers Staff
Health and Safety Orientation Manual   (review, sign Page 8 and return)
Appropriate Use and Security Policy and Agreement (review and electronically acknowledge via email on the last page)
Security Awareness Training Policy
Security Awareness Information
Remote Access Policy
Telework Plan| Telework Agreement (review, sign, and return)
Telework Duty Station Change form (PER34)


2023 JSP Salary Chart - Scranton, Williamsport, and Wilkes-Barre
2023 JSP Salary Chart - Harrisburg
Maintaining the Public Trust - Ethics for Federal Judicial Law Clerks
        As an employee of the United States District Court, Middle District of Pennsylvania, you are responsible for reviewing the online Personnel Manual and all other related policies and information located on the District Court’s intranet Human Resources Page upon hire.
   Welcome to the Court!