U.S. Department of State
In consideration of the payment by the Department of State of expenses incident to my appointment for travel,
transportation, moving and/or storage of household goods and personal effects and other applicable allowances for
myself and dependents as authorized under the Foreign Service Act of 1980, as amended, I hereby agree to remain in
the service of the United States Government for 12 months following the effective date of my transfer.
I further understand that I will not be eligible for separation travel and shipment of effects to my home of record if I
resign prior to completion of of service following the effective date of my transfer.
I further agree that, in case I violate the terms of this agreement during the above described 12 month period, unless
separated for reasons beyond my control and acceptable to the Department of State, all monies expended by the
United States Government for such travel, transportation, and other applicable allowances will become due and
payable by me and recoverable as a debt due the United States Government.
Full Name
12 months
Signature Date (mm-dd-yyyy)
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