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Office of Personnel Management STATEMENT OF PRIOR SERVICE - WORKSHEET
Name (Last, First, Middle Initial) Social Security Number Date of Birth (Month, Day, Year)

ADDITIONAL INSTRUCTIONS: Enter the appointment and separation dates in columns (A) and (B) below, using the numerical equivalent of the month. See Chapter 6 of The Guide to Processing Personnel Actions for instructions on computing service computation dates (SCDs). PART I - CREDITABLE SERVICE AND SERVICE COMPUTATION DATE FOR LEAVE PURPOSES CREDITABLE SERVICENAME OF AGENCY/ORGANIZATION (List only periods that are creditable for leave purposes) (A) APPOINTMENT DATE Year Month Day (B) SEPARATION DATE Year Month Day NONCREDITABLE SERVICE (Explain noncreditable time listed in Column (A), such as "lost time" during military service)

Entrance on Duty Date Total noncreditable service Total of appointment dates Total of separation dates SCD - Leave (A) (B) (A) - (B)

PARIT II - CREDITIBLE SERVICE AND SERVICE COMPUTATION FOR REDUCTION-IN-FORCE (RIF) PURPOSES Complete only in cases where the amount of service that is creidtable for RIF purposes differs from the amount creditable for leave purposes. CREDITABLE SERVICENAME OF AGENCY/ORGANIZATION (A) APPOINTMENT DATE Year
SCD - Leave (from Part I) Additional service creditable for RIF only

(B) SEPARATION DATE Year Month Day

Month

Day

NONCREDITABLE SERVICE (Explain noncreditable time listed in Column (A), such as "lost time" during military service)

Total noncreditable service Total of appointment dates Total of separation dates SCD - RIF (Service Date) REMARKS (A) (B) (A) - (B)

Name of Person Computing SCD(s) The Guide to Processing Personnel Actions

Date SCD(s) Computed Standard Form 144A Rev. July 2008 Previous editions not usable.

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