BOP Program Statement 3310.02 § 4

Forms will be maintained with the applicable certificate file.

REFERENCES

Program Statements

None.

Other Policy

5 U.S.C. 2301(b)

5 U.S.C. 2302(b)

5 U.S.C. 3110(b)

U.S. Department of Justice, Attorney General Memorandum dated 9/16/14

BP Forms

BP-A1097 Applicant/Employee Disclosure Form (also Attachment A)

BP-A1098 Selecting Official/Requesting Official Acknowledgement and Disclosure Form

(also Attachment B).

ACA Standards (see Program Statement, Directives Management Manual, sections 2.5 and 10.3)

■ American Correctional Association Standards for Adult Correctional Institutions, 4th

Edition: 4-4048.

■ American Correctional Association Performance Based Standards for Adult Local Detention

Facilities, 4th Edition: 4-ALDF-7B-05.

■ American Correctional Association Standards for Administration of Correctional Agencies,

2nd Edition: 2-CO-1C-01.

■ American Correctional Association Standards for Correctional Training Academies: None.

Records Retention

Requirements and retention guidance for records and information applicable to this program are

available in the Records and Information Disposition Schedule (RIDS) on Sallyport.

P3310.02 9/26/2016 6

Attachment A. BP-A1097 APPLICANT/EMPLOYEE DISCLOSURE FORM

APR 16

U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS

APPLICANTS: Thank you for your interest in the Department of Justice (DOJ). Having a relative already

employed at DOJ does not affect our consideration of you for employment; however, the information

requested below is necessary to help DOJ assure that all hiring decisions are free of inappropriate influence

by relatives employed in the Department and otherwise are consistent with applicable laws and policies.

EMPLOYEES: You must submit this certification in connection with a personnel action by which you will

move to a different position than the one you currently encumber.

Merit System Principles set forth in Section 2301(b) of Title 5, U.S.C. provide guidance on federal personnel

management. 5 U.S.C §§ 2302(b) and 3110(b) contain provisions identifying as a prohibited personnel

practice engaging in nepotism (i.e., to appoint, employ, promote, or advance relatives; or advocate for the same)

by public officials. It is also a prohibited personnel practice to grant a preference or advantage not authorized

by law, rule, or regulation to an employee or applicant for the purpose of improving or injuring any individual’s

prospects for employment. Consistent with these laws and applicable ethics requirements, you are asked to

identify relatives or other covered individuals (defined below) who work anywhere in the Department. For

purposes of this form, the term “relative” includes a DOJ employee’s or applicant’s spouse, parent, guardian,

grandparent, sister/brother (including step/half relationships), child/grandchild (including biological, adopted,

foster, or step child, legal ward, or child for whom the employee/applicant stands in loco parentis), in-law, aunt,

uncle, nephew, niece, or first cousin. “Other covered individuals” include a domestic partner, more distant

relatives than those listed above with whom the employee/applicant has a close personal relationship, or anyone

currently residing in the employee's/applicant's household, even temporarily.

• I do / do not have a relative or other covered individual who works for the

Department. Relevant details are provided below and on an attached page if necessary.

Name Relationship DOJ/BOP Duty Station

SIGNATURE, CERTIFICATION, AND RELEASE OF INFORMATION

YOU MUST SIGN THIS DOCUMENT. Read the following carefully before you sign.

 A false statement on any part of your application may be grounds for not hiring you, or for firing you after you

begin work. Also, you may be punished by fine or imprisonment (U.S. Code, title 18, section 1001).

 I certify that, to the best of my knowledge and belief, all of my statements are true, correct, complete, and

made in good faith.

Applicant/Employee Name (Please Print)

Date Signed (Month, day, year)

Applicant/Employee Signature

Reviewing Official Signature Date Signed (Month, day, year)

Please submit this form to

Privacy Act Notice: The information provided on this form is covered by and will be used and maintained in

accordance with the Privacy Act of 1974, as amended.

Attachment B. BP-A1098 APR 16 BOP SELECTING OFFICIAL ACKNOWLEDGMENT AND

DISCLOSURE FORM

U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS

Selecting Official Name: Applicant I Employee Name:

Organization/Component:

. .

Position:

I am familiar with the Merit System Principles found in Section 2301 (b) of title 5, U .S.C., which provide guidance

on federal personnel management, including 5 U.S.C §§ 2302(b) and 31 l 0(b), which contain provisions

identifying nepotism as a prohibited personnel practice. Nepotism is engaging in action to appoint, employ,

promote, or advance relatives, or advocate for any of these actions, by a public official.

I understand that:

 It is a prohibited personnel practice to grant a preference or advantage not authorized by law, rule, or

regulation to an employee or applicant for the purpose of improving or injuring any individual's

prospects for employment.

 The applicable ethics rules prohibit me from taking official action to affect my own financial interest,

or misusing my official position to promote a private interest, for example, by recommending my

domestic partner or a member of my household for a position at DOJ.

 For purposes of this form, the term “relative” includes a Department of J ustice (DOJ) applicant’s or

employee’s spouse, parent, guardian, grandparent, sister/brother (including step/half relationships),

child/grandchild (including biological, adopted, foster, or step child, legal ward, or child for whom the

employee stands in loco parentis), in-law, aunt, uncle, nephew, niece, or first cousin. “Other covered

individual” includes a domestic partner, a more distant relative not included above with whom the

employee has a close personal relationship, or anyone currently residing in the employee's or

applicant's household, even temporarily.

I understand that before l select a candidate for employment with DOJ or other personnel action (transfer,

reassignment, competitive promotion, or similar action), I must disclose on this form my knowledge of a

relative or other covered individual of an employee of DOJ, by responding to each of the following:

1. I certify that to the best of my knowledge:

The individual l am selecting I requesting does not have a relative or other covered individual employed at

DOJ;

(Initial Here)

OR

The individual I am selecting I requesting has a relative or other covered individual employed at DOJ.

(Initial Here)

2. If the individual I am selecting I requesting has a relative or other covered individual employed at DOJ, I

certify that my selection decision has not been influenced by either the selectee’s relationship with the

DOJ employee or any communication by the DOJ employee relating to the personnel action. (Initia l

Here) Not Applicable (i.e., I have no awareness of a relative

or other covered individual)

3. I am aware that individuals in the hiring process, including myself, may have had contact with a relative or

other covered individual of the selectee. If “yes,” I am satisfied it did not affect the personnel action and

have attached a brief explanation of the circumstances of which I am aware.

Yes No. If Yes, I have attached an explanation.

Names of relatives or other covered individuals known to work for DOJ:

Relative’s/Individual’s Name Relationship to Employee DOJ/BOP Duty Station

As the selecting official, I certify that the selection was made, or other personnel action was taken, in

compliance with Merit System Principles, and the applicable ethics rules.

SIGNATURE, CERTIFICATION, AND RELEASE OF INFORMATION

Selecting Official Signature & Date Reviewing Official Signature & Date

Please submit this form to

Privacy Act Notice: The information provided on this form is covered by and must be used and

maintained in accordance with the Privacy Act of 1974, as amended.