REQUEST FOR SPOUSAL PLACEMENT ASSISTANCE
Employee's Name:
Social Security No.:
Title, Pay Plan, Series, and Grade:
Current Duty Location/Address:
Employment Phone Number:
Home Address:
Home Phone Number:
Future Duty Location/Address:
Future Employment Phone Number:
Future Home Address (if known):
Future Home Phone Number (if known):
Expected Date of Reporting at Future Duty Station:
Spouse's Name:
Spouse's Social Security No.:
Spouse's Present Home Address/Phone Number (if different from Employee's):
Specific assistance requested from the servicing personnel office:
Type of position spouse is interested in obtaining at future duty station (if Federal service, please
indicate preferred series and grade, and attach copy of most recent SF-50, if available):
CONTINUE ON REVERSE OF THIS FORM