PS Form 2181-A "Pre-employment Screening - Authorization and Release"

What Is PS Form 2181-A?

PS Form 2181-A, Pre-Employment Screening - Authorization and Release is a form used for a multiple-component screening process consistently applied to all applicants who are to be selected for all United States Postal Service (USPS) positions regardless of the type of appointment. The information provided during the USPS pre-employment screening authorization is used to determine an individual's suitability for employment. Not only does it help the USPS to investigate the background of applicants, but is also used to verify the accuracy of potential employee's claims. It is not obligatory to share this information with your potential employer, but if it is not provided, you may not receive full consideration. Additionally, pre-employment screening helps to reduce the risk of turnover and protects the employer.

The latest version of the form - also known as the USPS Form 2181-A - was released on October 1, 2015, with all previous editions obsolete. An up-to-date PS Form 2181-A fillable version is available for download below.

The PS Form 2181-D (Disclosure and Authorization for Consumer Reports and Investigative Consumer Reports) is a related form used to disclose information about potential employee's background, such as identity information, credit reports, academic records, court records, criminal records, employment records, military service information, and driving records. An investigative consumer report is obtained through interviews to find out information about the applicant's character, personal characteristics, general reputation, and mode of living.

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USPS Pre-Employment Screening

Since the USPS is obligated to maintain public trust and the security of the mail, it is crucial to assure confidence in the integrity and reliability of its employees. Therefore, the USPS makes certain that individuals chosen for employment are carefully evaluated, screened, and deemed suitable for employment so that their conduct reflects favorably on the organization. The USPS collects, reviews, and stores several records - your application for employment, drug testing, police records. It helps to reward applicants who have earned their credentials, rather than individuals who present an application with false information.

The detailed screening process identifies applicants who possess the necessary abilities, skills, and qualifications to perform jobs in the postal service. Additionally, it is designed to disqualify unsuitable or ineligible applicants. Potential employees must meet certain criteria:

  1. Conscientiousness. Applicants have to demonstrate personal discipline, perform the essential duties effectively and competently, and behave ethically, and honestly;
  2. Communication. Potential employees must understand necessary instructions for effective and safe job performance, and receive and transmit information effectively;
  3. Cooperation. Applicants are required to work and cooperate well with other people, and contribute to positive work relations in order to avoid unnecessary conflict;
  4. Adaptability. Future postal service workers need to adapt well to supervisory, organizational, and technological changes, along with accepting and completing new or changed assignments.

The USPS pre-employment screening authorization (given through the PS Form 2181-A) is relatively simple and self-explanatory.

You are required to complete the PS Form 2181-A with your full name, the date of birth, the home telephone address and the email address. It is necessary to write down all other names you have used in the past (maiden name, other married name, nicknames) and dates when they were used. The USPS needs you to state all the places where you have lived, working back 5 years and accounting for all periods. You certify your consent and authorization to the disclosure of any relevant information and sign the form.

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Download PS Form 2181-A "Pre-employment Screening - Authorization and Release"

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Pre-Employment Screening —
Authorization and Release
.
Applicant: Carefully read the following information before you complete and sign this form
Privacy Act Statement: Your information will be used to determine your suitability for employment. Collection is authorized by
39 U.S.C. 401, 410, 1001, 1005, and 1206. Providing the information is voluntary, but if it is not provided, you may not receive full
consideration. We may only disclose your information as follows: in relevant legal proceedings; to law enforcement when the
®
USPS
or requesting agency becomes aware of a violation of law; to a congressional office at your request; to entities or individuals
under contract with USPS; to entities authorized to perform audits; to labor organizations as required by law; to federal, state, local,
or foreign government agencies regarding personnel matters; to the Equal Employment Opportunity Commission; and to the Merit
®
Systems Protection Board or Office of Special Counsel. For more information regarding our privacy policy visit us at usps.com
.
Home Telephone Number (include area code)
Applicant’s Name (last, first, MI)
Date of Birth (MM/DD/YYYY)
Email Address
Other Names and Dates Used: List all the names you have used in the past, beginning with the most recent (#1) and working
backward (#2, #3, etc.). You must list all names you have ever used and the dates you used each name.
If you need more space to provide complete information, please continue on the reverse side of this form.
#1 Previous Name Used
From Month/Year (MM/YYYY)
To:
#2 Previous Name Used
From Month/Year (MM/YYYY)
To:
#3 Previous Name Used
From Month/Year (MM/YYYY)
To:
Where You Have Lived: List the places where you have lived, beginning with the most recent (#1) and working back 5 years
(#2, #3, ect.). You must account for all periods. Be sure to indicate the actual physical location of your residence; do not list a
permanent address when you were actually living at a school address. Use the two letter Postal Service™ abbreviation code for
the state. If you need more space to provide complete information, please continue on the reverse side of this form.
#1 From Month/Year (MM/YYYY) Street Address
County
State
City
ZIP Code™
To: Present
#2 From Month/Year (MM/YYYY) Street Address
County
State
City
ZIP Code
To:
ZIP Code
#3 From Month/Year (MM/YYYY) Street Address
City
County
State
To:
#4 From Month/Year (MM/YYYY) Street Address
City
County
State
ZIP Code
To:
#5 From Month/Year (MM/YYYY) Street Address
County
City
State
ZIP Code
To:
This constitutes my consent and authorization to the disclosure or furnishing of any relevant and necessary information or records
to any duly authorized employment official or to a contractor acting on behalf of the United States Postal Service by any person,
corporation, agency, or association concerning my character, employment, criminal records, driving records, or military service as
may be relevant and necessary for a determination of my suitability for employment with the United States Postal Service.
This authorization is executed with full knowledge and understanding that the United States Postal Service will take measures to
protect the mentioned information against unauthorized disclosure to any parties not having a legitimate need for it in the discharge
of official business of the United States, or its agencies and instrumentalities.
I hereby release the mentioned persons, corporations, agencies, associations and their employees, agents, and representatives
from any and all liability for damages resulting from a decision by the United States Postal Service not to employ me on account of
compliance, or any attempts at compliance with this authorization, except for any damages resulting from knowingly providing false
or misleading information or records about me.
A copy of this authorization is as effective and valid as the original. If hired, this authorization is valid for the duration of my
employment to demonstrate continued suitability for employment with the United States Postal Service.
Printed Name of Applicant
Date Signed
Signature of Applicant
2181-A,
PS Form
October 2015 (PSN 7530-02-000-7401)
Pre-Employment Screening —
Authorization and Release
.
Applicant: Carefully read the following information before you complete and sign this form
Privacy Act Statement: Your information will be used to determine your suitability for employment. Collection is authorized by
39 U.S.C. 401, 410, 1001, 1005, and 1206. Providing the information is voluntary, but if it is not provided, you may not receive full
consideration. We may only disclose your information as follows: in relevant legal proceedings; to law enforcement when the
®
USPS
or requesting agency becomes aware of a violation of law; to a congressional office at your request; to entities or individuals
under contract with USPS; to entities authorized to perform audits; to labor organizations as required by law; to federal, state, local,
or foreign government agencies regarding personnel matters; to the Equal Employment Opportunity Commission; and to the Merit
®
Systems Protection Board or Office of Special Counsel. For more information regarding our privacy policy visit us at usps.com
.
Home Telephone Number (include area code)
Applicant’s Name (last, first, MI)
Date of Birth (MM/DD/YYYY)
Email Address
Other Names and Dates Used: List all the names you have used in the past, beginning with the most recent (#1) and working
backward (#2, #3, etc.). You must list all names you have ever used and the dates you used each name.
If you need more space to provide complete information, please continue on the reverse side of this form.
#1 Previous Name Used
From Month/Year (MM/YYYY)
To:
#2 Previous Name Used
From Month/Year (MM/YYYY)
To:
#3 Previous Name Used
From Month/Year (MM/YYYY)
To:
Where You Have Lived: List the places where you have lived, beginning with the most recent (#1) and working back 5 years
(#2, #3, ect.). You must account for all periods. Be sure to indicate the actual physical location of your residence; do not list a
permanent address when you were actually living at a school address. Use the two letter Postal Service™ abbreviation code for
the state. If you need more space to provide complete information, please continue on the reverse side of this form.
#1 From Month/Year (MM/YYYY) Street Address
County
State
City
ZIP Code™
To: Present
#2 From Month/Year (MM/YYYY) Street Address
County
State
City
ZIP Code
To:
ZIP Code
#3 From Month/Year (MM/YYYY) Street Address
City
County
State
To:
#4 From Month/Year (MM/YYYY) Street Address
City
County
State
ZIP Code
To:
#5 From Month/Year (MM/YYYY) Street Address
County
City
State
ZIP Code
To:
This constitutes my consent and authorization to the disclosure or furnishing of any relevant and necessary information or records
to any duly authorized employment official or to a contractor acting on behalf of the United States Postal Service by any person,
corporation, agency, or association concerning my character, employment, criminal records, driving records, or military service as
may be relevant and necessary for a determination of my suitability for employment with the United States Postal Service.
This authorization is executed with full knowledge and understanding that the United States Postal Service will take measures to
protect the mentioned information against unauthorized disclosure to any parties not having a legitimate need for it in the discharge
of official business of the United States, or its agencies and instrumentalities.
I hereby release the mentioned persons, corporations, agencies, associations and their employees, agents, and representatives
from any and all liability for damages resulting from a decision by the United States Postal Service not to employ me on account of
compliance, or any attempts at compliance with this authorization, except for any damages resulting from knowingly providing false
or misleading information or records about me.
A copy of this authorization is as effective and valid as the original. If hired, this authorization is valid for the duration of my
employment to demonstrate continued suitability for employment with the United States Postal Service.
Printed Name of Applicant
Date Signed
Signature of Applicant
2181-A,
PS Form
October 2015 (PSN 7530-02-000-7401)
Other Names and Dates Used (Continued):
#4 Previous Name Used
From Month/Year (MM/YYYY)
To:
#5 Previous Name Used
From Month/Year (MM/YYYY)
To:
#6 Previous Name Used
From Month/Year (MM/YYYY)
To:
Where You Have Lived (Continued):
Street Address
County
State
#6 From Month/Year (MM/YYYY)
City
ZIP Code™
To: Present
State
Street Address
City
County
ZIP Code
#7 From Month/Year (MM/YYYY)
To:
#8 From Month/Year (MM/YYYY) Street Address
State
ZIP Code
City
County
To:
Street Address
City
#9 From Month/Year (MM/YYYY)
County
State
ZIP Code
To:
#10 From Month/Year (MM/YYYY) Street Address
County
City
State
ZIP Code
To:
2181-A,
PS Form
October 2015 Reverse (PSN 7530-02-000-7401)
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