United S
tates Office of Personnel Management
Application for Senior Administrative Law Judge
OPM Form 1655
September 2018
Form Approved:
OM
B No. 3206-
0248
5 U.S.C. § 3323(b)
5 CFR 930.201 et seq
Description of the Senior Administrative Law Judge (SALJ) Program: The SALJ Program allows retired Administrative Law
Judges (ALJs) to be reemployed on a temporary and intermittent basis to complete hearings of one or more specified case(s) in
accordance with the Administrative Procedure Act of 1946. Upon appointment, and while reemployed, the retired ALJ is referred
to as a SALJ. (See 5 U.S.C. § 3323(b), and 5 CFR 930.201, et seq)
Who Can Apply: Federal ALJs who retired from the Federal Government, and who are currently receiving a federal annuity under
the Civil Service Retirement System (CSRS) or the Federal Employee Retirement System (FERS). Retired ALJs are required to
demonstrate through proper documentation that they are licensed and authorized to practice law under the laws of a State, the
District of Columbia, the Commonwealth of Puerto Rico, or other territorial court established under the Constitution. Judicial status
is acceptable in lieu of "active" status in States that prohibit sitting judges from maintaining "active" status to practice law. Being in
"good standing" is also acceptable in lieu of "active" status in States where the licensing authority considers "good standing" as
having a current license to practice law. If eligible, the U.S. Office of Personnel Management (OPM) will place the retired ALJs
name on its SALJ Master List for referral to a hiring agency for possible reemployment. Placement on the SALJ Master List is
not a guarantee of reemployment.
Instructions: Type or print clearly in black or blue ink. Complete the application and Geographic Preference Statement for Senior
Administrative Law Judge Applicant (OPM Form 1655-A). Submit your application and requested documentation to:
Administrative Law Judge Program Office, U.S. Office of Personnel Management, 1900 E Street, NW, Washington, DC 20415.
1. Name (Last, First, MI) 2. Last 5 Digits of SSN 3. Telephone Numbers
Daytime ( )
Other ( )
4. Address (Street, City, State, ZIP Code) 5. Email Address (if
available)
6. Are you a U.S. Citizen?
Yes
No
7. Highest Grade and Step/Level and Rate as ALJ
8. Retirement Date (mm/dd/yyyy)
9. Are you a Civil Service annuitant?
No Yes
CSRS
FERS
CSA Claim Number:
|
10. Do you meet the licensure requirements described above in "Who Can
Apply?"
Yes
No
If yes, list the state(s) and /or jurisdiction(s)
where you currently meet the licensure
requirements (attach proof of licensure):
11. Since the date of your original appointment as an ALJ, have you ever been
disciplined or cited for breach of ethics or unprofessional conduct by, or
been the subject of a complaint to, any court, administrative agency, bar
association, disciplinary committee, or other professional group?
Yes
No
If yes, in which jurisdiction: Please
describe the nature and outcome of the
proceeding (if needed, please attach a
separate sheet to this form):
12. List your ALJ experience. If desired, attach a resume
to this form.
From (mm/yyyy) To (mm/yyyy) Title Grade/Level Employer
(Agency)
Location
(City/State)
13. For which agencies are you interested in conducting hearings?
14. Availability to work:
Part Time Full Time
15. Are you willing to travel?
Yes No
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