The World of Computer Software/World_Of_Computer_Software-02-387-Vol-3of3.iso/n/newsf171.zip/SF171.OVL

Text File | 1992-06-01 | 44KB | 717 lines

GENERAL INFORMATION
1 What kind of job are you applying for?  Give title and
  annoucement number (if any)

────────────────────────────────────────────────────────────
2 If the annoucement lists several job titles, which jobs
  are you applying for?

────────────────────────────────────────────────────────────
3 Social Security Number  │ 4. Birth date (Month, Day, Year)
                          │
──────────┴──────┴────────┴─────────────────────────────────
5 Name (Last, First, Middle)

────────────────────────────────────────────────────────────
  Street address or RFD number (indicate apartment number,
  if any)

────────────────────────────────────────────────────────────
  City                           State             ZIP Code
                                │               │
────────────────────────────────┴───────────────┴───────────
6 Other names ever used  │ 7 Sex (for statistics use)
                         │   [ ] Male  [ ] Female
─────────────────────────┴──────────────────────────────────
8 Home Phone             │ 9 Work Phone
  Area Code  │ Number    │   Area Code │ Number    │Ext.
             │           │             │           │
─────────────┴───────────┴─────────────┴───────────┴────────
10 Were you ever employed as a civilian by the Federal
Government? If "NO", go to 11.  If "YES", mark each type of
job you held with an "X".

[ ]Temporary  [ ]Career-Conditional  [ ]Career  [ ]Excepted
What is your highest grade, classification series and job
title?

Dates at highest grade: FROM             TO
────────────────────────────────────────────────────────────
11 Do you have any applications for Federal employment on
file with the U.S. Office of Personnel Management? If "NO",
mark here [ ] and go to 12.  If "YES", write below and
continue in 47 the information for each application; (a) the
name of the office that has your application; (b) the title
of the job; (c) the date of your Notice of Results; and (d)
your rating.




────────────────────────────────────────────────────────────
AVAILABILITY
12 When can you start     │ 13 What is the lowest pay you
work? (Month and Year)    │    will accept?
                          │ Pay $       Per        Grade
──────────────────────────┴─────────────────────────────────
14 Are you willing to work:                         YES  NO
   A. In the Washington, D.C. metropolitan area? .. [  ][  ]
   B. Outside the 50 United States? ............... [  ][  ]
   C. Any place in the United States? ............. [  ][  ]
   D. Only in (list the location[s])
────────────────────────────────────────────────────────────
15 Are you willing to work:                         YES  NO
   A. 40 hours per week (full time)? .............. [  ][  ]
   B. 25-32 hours per week (part-time?) ........... [  ][  ]
   C. 17-24 hours per week (part-time)? ........... [  ][  ]
   D. 16 or fewer hours per week (part-time)? ..... [  ][  ]
   E. In an intermittent job (on-call/seasonal)? .. [  ][  ]
   F. Weekends, shifts, or rotating shifts? ....... [  ][  ]
────────────────────────────────────────────────────────────
16 Are you willing to take a temporary job lasting: YES  NO
   A. 5 to 12 months (sometimes longer)? .......... [  ][  ]
   B. 1 to 4 months? .............................. [  ][  ]
   C. Less than 1 month? .......................... [  ][  ]
────────────────────────────────────────────────────────────
17 Are you willing to travel away from home for:    YES  NO
   A. 1 to 5 nights each month? ................... [  ][  ]
   B. 6 to 10 nights each month? .................. [  ][  ]
   C. 11 or more nights each month? ............... [  ][  ]
────────────────────────────────────────────────────────────
MILITARY SERVICE AND VETERAN PREFERENCE
18 Have you served on active duty in the United
   States Military Service?  If your only duty
   was training in the Reserves or National         YES  NO
   Guard, answer "NO". If "NO", go to 22.           [  ][  ]
────────────────────────────────────────────────────────────
19 Were you honorably discharged from the military
   Service? If your discharge was changed to
   "honorable" or "general" by a Discharge Review
   Board, answer "YES". If you received a clemency  YES  NO
   discharge, answer "NO". If "NO" explain in 47.   [  ][  ]
────────────────────────────────────────────────────────────
20 Did you or will you retire at or above the rank  YES  NO
   of major or lieutenant commander?                [  ][  ]
────────────────────────────────────────────────────────────
21 List the dates, branch, and serial number for all active
duty service.
  FROM   │    TO    │ BRANCH OF SERVICE  │ SERIAL NUMBER
         │          │                    │
─────────┴──────────┴────────────────────┴──────────────────
         │          │                    │
─────────┴──────────┴────────────────────┴──────────────────
22 Place an "X" in the box next to your Veteran Preference
claim. Mark only one box. See the instructions for
eligibility information.
[1] NO PREFERENCE
[2] 5-POINT PREFERENCE - You must show proof when you are
    hired.
    10-POINT PREFERENCE - If you claim 10-point preference,
    you must complete a Standard Form 15, which is available
    at any Federal Job Information Center. ATTACH THE
    COMPLETED SF 15 TO THIS APPLICATION, TOGETHER WITH THE
    PROOF REQUESTED IN THE SF 15.
[3] Non-compensably disabled or Purple Heart recipent.
[4] Compensably disabled (less than 30%).
[5] Spouse, widow(er), or mother.
[6] Compensably disabled (30% or more).
────────────────────────────────────────────────────────────
23 May we ask your present employer about your
   character, qualifications and work record? A
   "NO" will not affect our review of your
   qualifications. If you answer "NO" and we need
   to contact your present employer before we can   YES  NO
   offer you a job, we will contact you first ..... [  ][  ]
────────────────────────────────────────────────────────────
24 READ WORK EXPERIENCE OF THE INSTRUCTION PAGE BEFORE YOU
   BEGIN
     o    Describe your current or most recent job in Block
          A and work backwards, describing each job you held
          during the past 10 years.
     o    You may sum up in one block work that you did more
          than 10 years ago. But, if that work is related to
          the type of job you are applying for, describe
          each related job in a seperate block.
     o    If you were unemployed for longer than 3 months,
          list the dates and your address(es) at that time
          in 47. Do not list unemployment that was more than
          10 years ago.
────────────────────────────────────────────────────────────
     o    INCLUDE VOLUNTEER WORK (NON-PAID WORK)-If the work
          (or a part of the work) is like the job you are
          applying for, complete all parts of the experience
          block just as you would for a paying job. You may
          receive credit for work experience with religious,
          community, welfare, service and other
          organizations.
     o    INCLUDE MILITARY SERVICE - You should complete all
          parts of the experience block just as you would
          for a non-military job, including all supervisory
          experience. Describe each major change of duties
          or responsibilities in a seperate experience
          block.
────────────────────────────────────────────────────────────
     o    IF YOU NEED MORE EXPERIENCE BLOCKS OR MORE SPACE
          TO DESCRIBE A JOB - For more blocks, use the
          SF 171-A or sheets of paper the same size as
          this page (be sure to include all information
          we ask for in A or B below). On each sheet show
          your name, Social Security Number, and the
          annoucement number or job title.
          For more space continue in 47 or on a sheet of
          paper as described above.
     o    IF YOU NEED TO UPDATE (ADD MORE RECENT JOBS), use
          the SF 172 or a sheet of paper as described above.
────────────────────────────────────────────────────────────
A Name and Address of employer's organiaztion (include ZIP
Code, if known)
────────────────────────────────────────────────────────────
Dates employed (give month and year)
From:           To:
────────────────────────────────────────────────────────────
Average number of hours per week

────────────────────────────────────────────────────────────
Salary or earnings
Starting $            per
Ending   $            per
────────────────────────────────────────────────────────────
Place of employment
City
State
────────────────────────────────────────────────────────────
Exact title of your job

────────────────────────────────────────────────────────────
Your immediate supervisor
Name                       │ Area Code │ Telephone Number
                           │           │
───────────────────────────┴───────────┴────────────────────
Number and job titles of any employees you supervise(d)


────────────────────────────────────────────────────────────
Kind of business or organization (manufacturing, accounting,
social service, etc.)

────────────────────────────────────────────────────────────
If Federal employment (civilian or military), list: series,
grade or rank, and the date of your promotion


────────────────────────────────────────────────────────────
Your reason for wanting to leave


────────────────────────────────────────────────────────────
Description of work: Describe your specific duties,
responsibilities and accomplishments in this job.  If you
describe more than one type of work (for  example, carpentry
and painting, or personnel and budget), write the
approximate percentage of time you spent doing each.


────────────────────────────────────────────────────────────
B Name and Address of employer's organiaztion (include ZIP
Code, if known)
────────────────────────────────────────────────────────────
Dates employed (give month and year)
From:           To:
────────────────────────────────────────────────────────────
Average number of hours per week

────────────────────────────────────────────────────────────
Salary or earnings
Starting $            per
Ending   $            per
────────────────────────────────────────────────────────────
Place of employment
City
State
────────────────────────────────────────────────────────────
Exact title of your job

────────────────────────────────────────────────────────────
Your immediate supervisor
Name                       │ Area Code │ Telephone Number
                           │           │
───────────────────────────┴───────────┴────────────────────
Number and job titles of any employees you supervise(d)


────────────────────────────────────────────────────────────
Kind of business or organization (manufacturing, accounting,
social service, etc.)

────────────────────────────────────────────────────────────
If Federal employment (civilian or military), list: series,
grade or rank, and the date of your promotion


────────────────────────────────────────────────────────────
Your reason for wanting to leave


────────────────────────────────────────────────────────────
Description of work: Describe your specific duties,
responsibilities and accomplishments in this job.  If you
describe more than one type of work (for  example, carpentry
and painting, or personnel and budget), write the
approximate percentage of time you spent doing each.


────────────────────────────────────────────────────────────
EDUCATION
25 Did you graduate from high school?  If you have a GED
high school equivalency or will graduate within the next
nine months, answer "YES".
YES [  ] If "YES", give month/year of Graduation:
NO  [  ] If "NO", give highest grade you completed:
────────────────────────────────────────────────────────────
26 Write the name and location (city and state) of the last
high school you attended

────────────────────────────────────────────────────────────
27 Have you ever attended college or graduate school?
YES [  ] If "YES", continue with 28.
 NO [  ] If "NO", go to 31.
────────────────────────────────────────────────────────────
28 NAME AND LOCATON (city, state and ZIP code) OF COLLEGE OR
UNIVERSITY.  If you expect to graduate within nine months,
give the month and year you expect to receive your degree.
────────────────────────────────────────────────────────────
1)
────────────────────────────────────────────────────────────
2)
────────────────────────────────────────────────────────────
3)
────────────────────────────────────────────────────────────
MONTH AND YEAR ATTENDED   │     NO. OF CREDITS COMPLETED
     From   │  To         │  Semester hours OR Quarter hours
────────────┴─────────────┴─────────────────────────────────
            │             │
────────────┴─────────────┴─────────────────────────────────
            │             │
────────────┴─────────────┴─────────────────────────────────
            │             │
────────────┴─────────────┴─────────────────────────────────
TYPE OF DEGREE            │         YEAR OF DEGREE
(e.g. B.A.,M.A.)          │
──────────────────────────┴─────────────────────────────────
                          │
──────────────────────────┴─────────────────────────────────
                          │
──────────────────────────┴─────────────────────────────────
                          │
──────────────────────────┴─────────────────────────────────
29 CHIEF UNDERGRADUATE SUBJECTS    NO. OF CREDITS COMPLETED
   Show major on the first line   Semester hrs OR Quarter hr
────────────────────────────────┴───────────────────────────
1)                              │
────────────────────────────────┴───────────────────────────
2)                              │
────────────────────────────────┴───────────────────────────
3)                              │
────────────────────────────────┴───────────────────────────
30 CHIEF GRADUATE SUBJECTS         NO. OF CREDITS COMPLETED
   Show major on the first line   Semester hr Or Quarter hr.
────────────────────────────────┴───────────────────────────
1)                              │
────────────────────────────────┴───────────────────────────
2)                              │
────────────────────────────────┴───────────────────────────
3)                              │
────────────────────────────────┴───────────────────────────
31 Have you completed any other courses or training related
to the kind of jobs you are applying for (for example, trade
vocational, Armed Forces, or busines)?  YES [  ]   NO [  ]
If "YES", give the information requested below.  (More
courses? - Use a sheet of paper).  If "NO", go to 32.
MONTH AND YEAR           TOTAL               SUBJECTS
   TRAINING            CLASSROOM
  COMPLETED              HOURS
─────────────────────┴───────────┴──────────────────────────
1)                   │           │
─────────────────────┴───────────┴──────────────────────────
2)                   │           │
─────────────────────┴───────────┴──────────────────────────
3)                   │           │
─────────────────────┴───────────┴──────────────────────────
NAME AND LOCATION OF SCHOOL             │   CERTIFICATE
(City,state,and ZIP CODE,if known)      │ DIPLOMA, ETC.
                                        │   (IF ANY)
────────────────────────────────────────┴───────────────────
1)                                      │
────────────────────────────────────────┴───────────────────
2)                                      │
────────────────────────────────────────┴───────────────────
3)                                      │
────────────────────────────────────────┴───────────────────
SPECIAL SKILLS, ACCOMPLISHMENTS AND AWARDS
32 List your special qualifications, skills or accomplish-
ment that may help you get a job.  Some examples are: skills
with machines; most important publications (do not submit
copies); public speaking and writing experience; membership
in professional or scientific societies; patents or inven-
tions; etc.


────────────────────────────────────────────────────────────
33 How many words per minute can you:
    TYPE?          TAKE DICTRATION?
────────────────────────────────────────────────────────────
34 List job-related licenses or certificates that you have,
such as: register nurse, lawyer, radio operator, driver's
pilots, etc.
LICENSE OR CERTIFICATE             DATE OF LATEST LICENSE
                                    OR CERTIFICATE
──────────────────────────────────┴─────────────────────────
1)                                │
──────────────────────────────────┴─────────────────────────
2)                                │
──────────────────────────────────┴─────────────────────────
STATE OR OTHER LICENSING AGENCY
1)
────────────────────────────────────────────────────────────
2)
────────────────────────────────────────────────────────────
Agencies may test your skills before hiring you
────────────────────────────────────────────────────────────
35 Do you speak or read a language othe than English
(include sign language)? Applicant for jobs that require a
language other than English may be given an interview
conducted solely in that language. YES [  ]      NO [  ]
If "YES",list each language and place an "X" in each column
that applies to you. If "NO", go to 36.
           │ CAN PREPARE AND          │ CAN SPEAK AND
LANGUAGE(S)│  GIVE LECTURES           │  UNDERSTAND
           │ Fluenty │With Difficulty │ Fluenty │ Passably
───────────┴─────────┴────────────────┴─────────┴───────────
1)         │         │                │         │
───────────┴─────────┴────────────────┴─────────┴───────────
2)         │         │                │         │
───────────┴─────────┴────────────────┴─────────┴───────────
CAN TRANSLATE ARTICLES       │ CAN READ ARTICLES FOR OWN USE
Into English  From English   │   Easily    With Difficulty
─────────────┴───────────────┴──────────┴───────────────────
1)           │               │          │
─────────────┴───────────────┴──────────┴───────────────────
2)           │               │          │
─────────────┴───────────────┴──────────┴───────────────────
36 List any honors, awards, or fellowships you have
received. For each, give the year it was recieived.
────────────────────────────────────────────────────────────
REFERENCES
37 List three people who are not related to you and who know
your qualifications and fitness for the kind of job(s) for
which you are applying. Do not list supervisors you listed
under 24.
FULL NAME OF REFERENCE  PRESENT BUSINESS OR HOME ADDRESS
                        (Number, street, city, state and ZIP
───────────────────────┴────────────────────────────────────
1)                     │
───────────────────────┴────────────────────────────────────
2)                     │
───────────────────────┴────────────────────────────────────
3)                     │
───────────────────────┴────────────────────────────────────
TELEPHONE NUMBER(S)    │       BUSINESS OR OCCUPATION
(include area code)    │
───────────────────────┴────────────────────────────────────
1)                     │
───────────────────────┴────────────────────────────────────
2)                     │
───────────────────────┴────────────────────────────────────
3)                     │
───────────────────────┴────────────────────────────────────
BACKGROUND INFORMATION - YOU MUST ANSWER EACH QUESTION IN
THIS SECTION BEFORE WE CAN PROCESS YOUR APPLICATION

 Place an "X" in the proper column for each queation below.

38 Are you a citizen of the United States?         YES  NO
   If "NO", write the country or countries        [  ] [  ]
   you are a citizen of:

   ────────────────────────────────────────────────────────
IMPORTANT NOTE ABOUT 39 THROUGH 44: We will consider the
date, facts, and circumstances of each event you list. In
most cases you can still be considered for Federal jobs.
However, if you fail to tell the truth or fail to list all
relevant events, this failure may be grounds for not hiring
you, for firing you after you begin work, or for criminal
prosecution [18 USC 1001].
────────────────────────────────────────────────────────────
39 During the last 10 years, were you fired
from any job for any reason, did you quit
after being told that you would be fired,
or did you leave by mutual agreement because       YES  NO
of specific problems?                              [  ][  ]

If "YES", use 47 to write for each job: a) the name of the
employer; b) the approximate date you left the job; c) the
reason(s) why you left.
────────────────────────────────────────────────────────────
WHEN ANSWERING QUESTIONS 40 THROUGH 44 YOU MAY OMIT:
1) traffic fines of $100.00 or less, 2) any violation of law
committed before your 18th birthday, if finally decided in
juvenile court or under a youth offender law; 3) any
conviction set aside under the Federal Youth Corrections
Acts or similar State law; 4) sny conviction whose record
was expunged under Federal or State law.
────────────────────────────────────────────────────────────
40 Have you ever been convicted of or              YES  NO
forfeited collateral for any felony?               [  ][  ]

 A felony is defined as any violation of law punishable by
imprisonment of longer than one year, except for violations
called misdemeanors under State law which are punishable by
imprisonment of two years or less.
────────────────────────────────────────────────────────────
41 Have you ever been convicted of or
forfeited collerteral for any firearms             YES  NO
or explosives violations?                          [  ][  ]
────────────────────────────────────────────────────────────
42 During the last 10 years have you
forfeited collertal, been convicted,
been imprisoned, been on probation, or
been on parole?  Do not include viola-             YES  NO
tions reported in 40 or 41 above.                  [  ][  ]

43 Are you now under charges for any               YES  NO
violation of law?                                  [  ][  ]
────────────────────────────────────────────────────────────
44 Have you ever been convicted by a court-        YES  NO
martial? If no military service, answer "NO".      [  ][  ]


IF YOU ANSWER "YES" TO 40, 41, 42, 43, OR 44, GIVE DETAILS
IN 47.  FOR EACH VIOLATIONS WRITE THE : 1) DATE; 2) CHARGE;
3) PLACE; 4) COURT; AND 5) ACTION TAKEN.
────────────────────────────────────────────────────────────
45 Do any of your relatives work for the
United States Government or the United
States Armed Forces?  Include: father;
mother; husband; wife; son; daughter;
brother; sister; uncle; aunt; first
cousin; nephew; niece; father-in-law;
mother-in-law; son-in-law; daughter-in-law;
brother-in-law; sister-in-law; stepfather;
stepmother; stepson; stepdaughter;
stepbrother; stepsister; half brother; and         YES  NO
half sister.                                       [  ][  ]
────────────────────────────────────────────────────────────
46 Do you receive, or have you ever applied
for retirement pay, pension, or other pay
based on military, Federal cilivian, or            YES  NO
District of Columbia Government service?           [  ][  ]
────────────────────────────────────────────────────────────
ADDITIONAL SPACE FOR ANSWERS
47 Write the number to which each answer applies.  If you
need more space, use sheets of paper the same size as this
page.  On each sheet write your name, Social Security Number
and the announcement number or job title.  Attach all
additional sheets at the top of page 3.
────────────────────────────────────────────────────────────
SIGNATURE, CERIFICATION, AND RELEASE OF INFORMATION
YOU MUST SIGN THIS APPLICATION. Read the following carefully
before you sign.

A false statement on any part of your application may be
grounds for not hiring you, or for firing you after you
begin work.  Also, you may be punished by fine or
imprisonment (U.S. Code, Title 18, Section 1001).
I understand that any information I give may be investigated
as allowed by law or Presidential order; I consent to the
release of information about my ability and fitness for
Federal employment by employers, schools, law enforcement
agencies and other individuals and organizations, to
investigators, personnel stafffing specialists, and other
authorized employees of the Federal Government.  I certify
that, the the best of my knowledge and beleif, all of my
statements are true, correct, complete, and made in good
faith.
────────────────────────────────────────────────────────────
48 SIGNATURE ( Sign each application in dark ink)

       [ Once you have completed printing the form.]

49 DATE SIGNED (Month, Day, Year)

            [ Print on the form that you sign.]

────────────────────────────────────────────────────────────
DO NOT SUBMIT A RESUME INSTEAD OF THIS APPLICATION.

TYPE OR PRINT CLEARLY IN DARK INK.  If you need more space
for an answer, continue in item 47 on page 4 or use a sheet
of paper the same size as this page.  On each sheet write
your name, Social Security Number, and the announcement
number or job title.  Attach all sheets to this application
at the top of page 3.

If you do not answer all questions fully and correctly, you
may delay our review of your application and lose job
opportunities.
────────────────────────────────────────────────────────────
Unless we ask you for additional material in the announce-
ment or qualification information, do not attach any
materials, such as: offical position descriptions, perform-
ance evaluations, letters of recommendation, certificates of
training, publications, etc.  Any materials you attach which
we did not ask for may be removed from your application and
will not be returned to you.

We suggest that you keep a copy of this application for your
use.  If you plan to make copies of your application, we
suggest you leave items 1, 2, 48, and 49 blank.  Complete
these blank items each time you apply.  YOU MUST SIGN AND
DATE, IN INK, EACH COPY YOU SUBMIT.
────────────────────────────────────────────────────────────
If you are applying for a specific for a Federal civil
service examination (whether or not a written test is
required):
- Read the annoucement and other material provided.  Make
sure that your work experience and/or education meet the
qualifications described.
- Make sure that you are allowed to apply at this time.
Civil service examinations may be closed to receipt of new
applications for specific types of jobs, grade levels,
and/or geological locations.  Follow any directions on How
to Apply.
────────────────────────────────────────────────────────────
- If a written test is required, follow the instructions on
your admission card (for example: Bring a completed SF171 to
the test).
- If a written test is not required, mail this application
to the address in the annoucement.
- Include all forms required by the annoucement.
────────────────────────────────────────────────────────────
If you are applying for a specific vacancy in a Federal
agency:
- Study the vacancy annoucement to make sure that you meet
the qualifications for the job and are allowed to apply.
Some jobs are limited to people who work for the Federal
Government, have worked for the Federal Governement in the
past, or hove an application on file with the Office of
Personnel Management.
- Mail this appplication to the address in the vacancy
annoucement.
- Include all forms that are required by the annoucement.

If you change your address, notify all offices that have
your application.  Always include your Social Security
Number.
────────────────────────────────────────────────────────────
WORK EXPERIENCE (Item 24)
Carefully complete each experience block you need to
describe your work experience.  Unless you qualify based on
education alone, your rating will depend on your description
of previous jobs.  Do not leave out any jobs you held during
the last ten years.

Under Description of Work, write a clear and brief, but
complete description of your major duties and responsibil-
ities for each job.  Include any supervisory duties, special
assignments, and your accomplishments in the job.  We may
verify your description with your former employers.
────────────────────────────────────────────────────────────
If you had a major change of duties or responsibilities
while you worked for the same employer, describe each major
change as a seperate job.

Write in each experience block your name at that time, if it
is different form the name you currently use.  Show your
former name in parenteses on the first line under
DESCRIPTION OF WORK.
────────────────────────────────────────────────────────────
VETERAN PREFERANCE (Item 22)
DO NOT LEAVE 22 blank.  If you do not claim veteran
preference, place an -X- in box number 1, NO PREFERENCE.

You cannot receive veteran preference if you are retired, or
plan to retired, at or above the rank of major or lieutenant
commander, unless you have a service-connected disability
(see 10-POINT PREFERENCE below).

Some Vietnam Era and disabled veterans qualify for special
hiring programs.  More information is available from any
Federal Job Information Center.
────────────────────────────────────────────────────────────
5-POINT PREFERENCE.  If you claim 5-point preference you
must have:
- Received an honorable or general discharge (a clemency
discharge does not meet the requirements of the Veteran
Preference Act); and
- Served on active duty anytime between December 7, 1941,
and July 1, 1955; or
────────────────────────────────────────────────────────────
- Served more than 180 consecutive days of active duty, any
part of which was agter January 31, 1955, and before October
15, 1976 (do not count active duty for training under the
6-month Reserve or National Guard programs); or
- Served in a military action for which you recieved or were
entitled to receive a Campaign Badge or Expeditionary Medal.
Write  the names of your Campaign Badges and Expenditary
Medals in 47.
If you claim 5-point preference place an -X- in box number 2
marked 5-POINT PREFERENCE.
────────────────────────────────────────────────────────────
10 POINT PREFERENCE.  If you claim 10-point preference you
must meet the requirements for one of the groups below, as
described in the Standard Form 15, Application for 10-Point
Veteran Preference (SF-15).  The SF-15 is available by mail
from any Federal Job Information Center.
- Non-Compensably Disabled or Purple Heart Recipient;
- Compensably Disabled (less than 30%);
- Spouse, Widow(er), or Mother of a deceased or diabled
veteran.
If you claim 10-point preference, place an -X- in the box
that applies to you (3 or 4 or 5 or 6).  ATTACH A COMPLETED
SF-15 TO THIS APPLICATION TOGETHER WITH THE PROOF REQUESTED
IN THE SF-15.
────────────────────────────────────────────────────────────
PRIVACY ACT STATEMENT
  The Office of Personnel Management is authorized to rate
applicants for Federal jobs under sections 1302, 3301, and
3304 of title 5 of the U.S. Code.  Section 1104 of title 5
allows the Office of Personnel Management to authorize other
Federal Agencies to rate applicants for Federal jobs.  We
need the information you put on this form and associated
application forms to see how well your education and work
skills qualify you for a Federal job.  We also need
information on matters such as citizenship and military
service to see weather you are affected by laws we must
follow in deciding who may be employed by the Federal
Government.
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  We must hove your Social Security Number (SSN) to keep
your records straight because other people may have the same
name and birthdate.  The SSN has been used to keep records
since 1943, when Executive Order 9397 asked agencies to do
so.  The Office of Personnel Management may also use your
SSN to make requests for information about you from
employers, schools, banks, and others who know you, but only
as allowed by law or Presidential directive.  The
information we collect by using your SSN will be used for
employment purposes and also for studies and statistics that
will no identify you.
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  Information we have about you may also be given to
Federal, State and local agencies for checking on law
violations or for other lawful purposes.  We may send your
name and address to State and local Government agencies,
Congresstional and other pulic offices, and public
international organizations, if they request names of people
to consider for employment.  We may also notify your school
placement office if you are selected for Federal job.
  Giving us your SSN or any of the other information is
voluntary.  However, we cannot process your application,
which is the first step toward getting a job, if you do not
give us the information we request.
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Application for Federal Employment - SF 171
Read the instructions before you complete this application.
Type or print clearly in dark ink.
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