AUTHORIZATION FOR RELEASE OF INFORMATION Carefully read this authorizationto release information about you, then sign and date it in ink. I authorize custodians of records and sources of information pertaining to my Federal employment to release such information upon request of the investigator, special agent, or other duly accredited representative of any Federal agency examining my fitness for the position of immigration judge, regardless of any previous agreement to the contrary. I understand that in this instance, the information released by records custodians and sources of infomation is for official use by the Federal Government for the specific purpose of consideration for the position of immigration judge with the United States Department of Justice, Executive Office for Immigration Review. Copies of this authorization that show my signature are as valid as the original release signed by me. f4 $&I1 Date 6 IMMIGRATION JUDGE APPLICANT NOTICE STATEMENT: CLEARANCES I understand that all applicants selected for an Immigration Judge position must undergo a thorough background investigation by the Federal Bureau of Investigation (FBI). I understand that this investigation will include, but is not limited to, name checks, fingerprint checks, tax record checks, and credit m r d checks. I also understand that I must submit annually a public financial disclosure statement and that 1 wiIl be subject to periodic re-investigation by the FBI. To the.best of my knowledge, there is no information in my background such as tax delinquencies, poor credit record, convictions, or other matters that may be problematic during the course of this background investigation, except as explained in the space below (or on an attached sheet). Also, I do not have a drug, alcohol, or other substance abuse problem. NIA I do have an active TS/SCI security clearance. - I acknowledge receipt of this notice and attest to the accuracy of the statement above (and supplementary explanation to the statement above). Date IMMIGRATION JUDGE APPLICANT NOTICE STATEMENT: CONDITIONS OF WORK, TRANSFER,AND TRAVEL 1. Tmvel. Jmmigration Judges are required to travel as a condition of employment. This travel may be fkquent or sporadic, depending on the circumstances and managerid need. Travel assignments can last for periods of two to three weeks at a time. An immigration court docket usually runs from early on Monday rnmings to the close of business on Fridays and, consequently, travel may be required before or aRer normal working hours or on weekends. 2. Transfer r e q w f i . Once offered a position in a given location, an Immigration Judge must be prepared to stay at that location. There is no express or implied guarantee of future transfer, nor is the agency under any obligation to transfer an Immigration Judge to any other location at any time. 3. Moving expenses. If an Immigration Judge accepts a position at a location that requires him or her b relocate a personal residence, relocation expenses will not be provided or authorized. Similarly, relocation expenses to accommodate a voIuntary transfer will not be provided or authorized. 4. Detained l m i i ~ n s . Many immigration proceedings are conducted in penal institutions, detention centers, and other confinement settings. Immigration Judges may be permanently assigned or temporarily detailed to such a location. 5. Specialized dockets. Immigration Judges sometimes hold speciaiized dockets. Dockets in some locations might be exclusively asylum cases or handled though video-teleconferencing. Specialized docIc.e@can, last for an indefinite period of time. 6. Temporayfaciiitk. Occasionally, adequate courtroom facilities are not completed and available at the time an Immigration Judge enters on duty. In that instance, the Immiphon Judge may be called upon to conduct hearings in temporary courtroom space or temporary court facilities. I certify that I have read this notice statement. 2 g f l ~ ~ Date IMMIGRATION JUDGE APPLICANT SUPPLEMENTAL INFORMATION CHECKLIST Your submission must contain all of the following items: IMMIGRATION JUDGEAPPLICANT NOTICE STATEMENT: CONDITIONS OF WORK, TRANSFER, AND TRAVEL - Form #2 IMMIGRATION JUDGEAPPLICANT NOTICESTATEMENT: CLEARANCES - Form # 3 REFERENCES - Form #4 EMPLOYMENT CONTACTS (last 7 years) - Form #5 AUTHORIZATION FOR RELEASE OF INFORMATION - Form #6 IMMIGRATION JUDGE VACANCY INTERVIEW LIST - Form #7 Your supplemental information should be mailed to: Office of the Chief Immigration Judge Executive Office for Immigration Review 5 107 Leesburg Pike, Suite 2500 Falls Church, VA 22041 And it must be received by EOIR by: April 8,2016 Do not scan, email or fax your submission. You may deliver your supplemental information on the day of your interview. Questions can be directed to: (703) 305-1247 U.S. Department of Justice Executive Ofice for Immigration Review Office of the Chief Immigration Judge 5107 Leesbwg Pike, Suite 2500 Fulls Chwch, Virginia 22041 To: Re: Date: Immigration Judge Applicant Supplemental Information Required Mmh 1,2016 You have k e n scheduled to interview for an Immigration Judge position in response to our pgstd advertisement. As part of the interview process, we reauest that you mint. review atld complete the materials enclosed in this attachment. Please note that h i s attachment contains a "Supplemen#ub Information CheckJist, identifying each item that you must return to this office. Also please note that t h e is a deadline of April 8,2016 for submitting the additional materials, or the alternative, you may bring them with you to the interview. If you have questions about the materials or the deadline, please call the contact person on the encIosed checklist. " The enclosed forms may be typed or legibfy bandwritten. Do not submit the information in any other document or fonnat. Do not scan, email or fax your submission. AdditionaIly, if you have had any change in employment or would like to supplement your application, please submit that information at this t h e . Thank you for your interest and your prompt response.