Federal Employment Age Waiver Request Form

Federal Employment Age Waiver Request Form
Use this form to request an age waiver for federal employment by providing your contact information, requested position details, and justification for review.
Applicant Information
Full Name
First NameMiddle NameLast Name
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Waiver Request Details
Current Age
Position or Department Sought
Requested Start Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Reason for Age Waiver Request
Supporting Declaration
Signature Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: