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This version of the form is not currently in use and is provided for reference only. Download this version of
Form DS-0109
for the current year.
Form DS-0109 Separation Statement
What Is Form DS-0109?
This is a legal form that was released by the U.S. Department of State on March 1, 2015 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DS-0109?
A: Form DS-0109 is the Separation Statement form.
Q: What is the purpose of Form DS-0109?
A: The purpose of Form DS-0109 is to document the separation of an employee from a government agency.
Q: Who needs to fill out Form DS-0109?
A: Employees who are separating from a government agency need to fill out Form DS-0109.
Q: Is Form DS-0109 mandatory?
A: Yes, Form DS-0109 is mandatory for employees separating from a government agency.
Form Details:
- Released on March 1, 2015;
- The latest available edition released by the U.S. Department of State;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DS-0109 by clicking the link below or browse more documents and templates provided by the U.S. Department of State.
