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Asymetrix ToolBook File | 1993-09-10 | 248KB | 3,619 lines

171LONG #@$:#[ ADDITIONAL WORK EXPERIENCE BLOCKS Average number of Name and address of employer's organization (including ZIP Code, if known) Dates employed (give month, day and year) hours per week Number of employees you supervised From: To::::: Salary or earnings Your reason for leaving to leave Starting $ perrrrrr Ending $ perrrrrrr U#B U# n(B n(1 Your immediate supervisor Area Code Telephone No. Exact title of your job If Federal employment (civilian or military) list series, grade orr rank, and, if promoted in this job, the date of your last promotionnb, the date of your last promotion Description of work: Describe your specific duties, responsibilities and accomplishments in this job, including the job title(s) of any employees you supervised. 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. .;_..; Standard Form 171-A Continuation Sheet for SF 171 Attach all SF 171-A's to your application at the top of page 3..I 1. Name (Last, First, Middle Initial) 3. Job Title or Announcement Number You Are Applying For 2. Social Security Number 4. Date Completed OMB No. 3206-001222 No. 3206-0012 Form Approved: OMB No. 3206-0012 THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER PREVIOUS EDITION USABLE UNTIL 12-31-90ORTUNITY EMPLOYER ;I/]< Standard Form 171-A (Rev. 6-88) U.S. Office of Personnel Management FPM Chapter 295 DESCRIPTION3 SUPERVISOR JOB TITLE ecordField enterRecordField leaveRecordField enterRecordField leaveRecordField eaveRecordField PROMOTION DATE LEAVING ecordField enterRecordField leaveRecordField enterRecordField leaveRecordField eaveRecordField JOB TITLE rAddress ecordField enterRecordField leaveRecordField enterRecordField leaveRecordField eaveRecordField employees STARTING ENDING Address2 BLOCK1 U#!9Y..; #U#$ X$H! U#!9Y. $!9K.c: For Agency Use (skill codes, etc.) :X$.; 171LONG Background Extra Paper LEAVEPAGE LEAVEPAGE button 15AYES CHECKED 15AYES PAGE1 15AYES PAGE1 15ANO CHECKED 15ANO PAGE1 15ANO PAGE1 15BYES CHECKED 15BYES PAGE1 15BYES PAGE1 15BNO CHECKED 15BNO PAGE1 15BNO PAGE1 15CYES CHECKED 15CYES PAGE1 15CYES PAGE1 15CNO CHECKED 15CNO PAGE1 15CNO PAGE1 16AYES CHECKED 16AYES PAGE1 16AYES PAGE1 16ANO CHECKED 16ANO PAGE1 16ANO PAGE1 16CNO CHECKED 16CNO PAGE1 16CNO PAGE1 16BYES CHECKED 16BYES PAGE1 16BYES PAGE1 16BNO CHECKED 16BNO PAGE1 16BNO PAGE1 16CYES CHECKED 16CYES PAGE1 16CYES PAGE1 17YES CHECKED 17YES PAGE1 17YES PAGE1 CHECKED PAGE1 PAGE1 18YES CHECKED 18YES PAGE1 18YES PAGE1 CHECKED PAGE1 PAGE1 enterRecordField leaveRecordField keyChar enterRecordField getSystemMetrics video video leaveRecordField keyChar video sysCaretPosition video sysCaretPosition Courier8 Courier9 LeaveBackground Courier10 TimesNewRoman8 TimesNewRoman9 NextPage TimesNewRoman10 EnterBackground System ClearCurrent171A keyup etPosition sysCaretPosition getCaretLoc EnterBackground ExtraPage NextPage ExtraPage ExtraPage &Fonts Courier 8 &Fonts Courier 9 &Fonts Courier 10 &Fonts Times New Roman 8 &Fonts Times New Roman 9 &Fonts Times New Roman 10 &Fonts System &Fonts GetCaretPos GetSystemMetrics tbkwin.dll pageFromClient kernel globalAlloc globalFree globalLock globalUnlock globalAlloc globalLock lpMem LeaveBackground ExtraPage &Fonts kernel tbkwin.dll globalUnlock globalFree lpMem NextPage Courier8 description Courier description2 Courier description description2 Courier9 description Courier description2 Courier description description2 Courier10 description Courier description2 Courier description description2 TimesNewRoman8 description Times New Roman description2 Times New Roman description description2 TimesNewRoman9 description Times New Roman description2 Times New Roman description description2 TimesNewRoman10 description Times New Roman description2 Times New Roman description description2 System description System description2 System ClearCurrent171A Are you sure? This will clear your current 171A page. DESCRIPTION DESCRIPTION2 raddress supervisor job title promotion date leaving employees ending starting address2 supervisor2 area2 tele2 job title2 promotion date2 leaving2 employees2 from2 ending2 starting2 per1b per2b BLOCK1 BLOCK2 sysCaretPosition GetCaretPos pageFromClient lpMem getCaretLoc sysCaretPosition textfrompoint keyup getCaretLoc enterRecordField leaveRecordField keyChar enterRecordField getSystemMetrics video video leaveRecordField keyChar video sysCaretPosition video sysCaretPosition 171A LONG1 EnterPage LeavePage EnterPage NextPage Clear Current 171A &Clear LeavePage NextPage ExtraPage Clear Current 171A NextPage Clear Current 171A &Clear LeavePage NextPage ExtraPage Clear Current 171A FFSFSS enterRecordField leaveRecordField keyChar enterRecordField getSystemMetrics video video leaveRecordField keyChar video sysCaretPosition video sysCaretPosition LEAVEPAGE LEAVEPAGE button DISCHARGE DATE SCREEN5 DISCHARGE DATE PAGE1 TYPE DISCHARGE SCREEN5 TYPE DISCHARGE PAGE1 20FROM SCREEN5 20FROM PAGE1 SCREEN5 PAGE1 20SERVICE SCREEN5 20SERVICE PAGE1 20FROM2 SCREEN5 20FROM2 PAGE1 20TO2 SCREEN5 20TO2 PAGE1 20SERVICE2 SCREEN5 20SERVICE2 PAGE1 19YES CHECKED 19YES PAGE1 19YES PAGE1 CHECKED PAGE1 PAGE1 questions21to22 questions22Contto23 ENTERBOOK question24A ClearBaselines question24B questions25TO27 question28 SF171HELP questions29TO30 reader question31 questions32TO33 questions1to7 questions34TO35 question35CONT question36 questions8to11 questions37to38 questions39to44 author question45 questions12to14 questions46to47 question47Cont questions48to49 ClearallEntriesPages ExtraPage Page171A Page171ALong PreviewPage1 questions15to18 PreviewPage2 PreviewPage3 questions19to20 PreviewPage4 Return leaveBook author sizeToPage secret reader BUTTON secret video ENTERBOOK BUTTON agreement sizeToPage &Clear Clear &all entries pages &Clear Clear Baselines &Clear &Import... &Export... Select Page Preview Page 1 &File Preview Page 2 &File Preview Page 3 &File Preview Page 4 &File &Goto &Help &SF171 Help &Help &Home &Goto Extra Page &Goto Page 171A &Goto Page 171A Long &Goto Questions 1 to 7 &Goto Questions 8 to 11 &Goto Questions 12 to 14 &Goto Questions 15 to 18 &Goto Questions 19 to 20 &Goto Questions 21 to 22 &Goto Questions 22 Cont to 23 &Goto Question 24A &Goto Question 24B &Goto Questions 25 to 27 &Goto Question 28 &Goto Questions 29 to 30 &Goto Question 31 &Goto Questions 32 to 33 &Goto Questions 34 to 35 &Goto Question 35 Cont &Goto Question 36 &Goto Questions 37 to 38 &Goto Questions 39 to 44 &Goto Question 45 &Goto Questions 46 to 47 &Goto Question 47 Cont &Goto Questions 48 to 49 &Goto Return &Goto USERNUMBER user version text Unlimited user version USERNUMBER user version text Single user version USERNUMBER user version text Two user version USERNUMBER user version text Eight user version reader sizetoPage Description DESCRIPTION DESCRIPTION2 DESCRIPTION3 171LONG ADDITIONAL WORK Background Extra Paper DESCRIPTION DESCRIPTION2 DESCRIPTION3 171LONG ADDITIONAL WORK Background Extra Paper RegUser AGREEMENT ClearBaselines ClearallEntriesPages Are you sure? This will clear your data entry screens only, not your 171As or Extrapages. SCREEN1 SCREEN1 SCREEN1 SCREEN1 SCREEN1 SCREEN1 ADDRESS SCREEN1 SCREEN1 STATE SCREEN1 SCREEN1 SCREEN2 SCREEN2 SCREEN2 SCREEN2 SCREEN2 TO DATE SCREEN2 FROM DATE SCREEN2 HIGHEST JOB SCREEN2 START WORK SCREEN2 SCREEN3 SCREEN3 GRADE SCREEN3 SCREEN3 DISCHARGE DATE SCREEN5 TYPE DISCHARGE SCREEN5 20FROM SCREEN5 SCREEN5 20SERVICE SCREEN5 20FROM2 SCREEN5 20TO2 SCREEN5 20SERVICE2 SCREEN5 SCREEN6 SCREEN2 CONDITIONAL SCREEN2 CAREER SCREEN2 EXPECTED SCREEN2 14AYES SCREEN3 14BYES SCREEN3 14CYES SCREEN3 14DYES SCREEN3 14EYES SCREEN3 14FYES SCREEN3 14ANO SCREEN3 14BNO SCREEN3 14CNO SCREEN3 14DNO SCREEN3 14ENO SCREEN3 14FNO SCREEN3 15ANO SCREEN4 15BNO SCREEN4 15CNO SCREEN4 15AYES SCREEN4 15BYES SCREEN4 15CYES SCREEN4 16ANO SCREEN4 16BNO SCREEN4 16CNO SCREEN4 16AYES SCREEN4 16BYES SCREEN4 16CYES SCREEN4 SCREEN4 17YES SCREEN4 SCREEN4 18YES SCREEN4 SCREEN5 19YES SCREEN5 DISCHARGE DATE SCREEN5 TYPE DISCHARGE SCREEN5 20FROM SCREEN5 SCREEN5 20SERVICE SCREEN5 SCREEN6 SCREEN6 22PREF SCREEN6 SCREEN7 SCREEN7 SCREEN7 SCREEN7 BUTTON ClearBaselines Description DESCRIPTION DESCRIPTION2 DESCRIPTION3 171LONG ADDITIONAL WORK Background Extra Paper DESCRIPTION DESCRIPTION3 171LONG DESCRIPTION2 ADDITIONAL WORK Background Extra Paper ClearBaselines SF171HELP WINHELP.EXE 171HELP.HLP questions1to7 screen1 questions8to11 screen2 questions12to14 screen3 questions15to18 screen4 questions19to20 screen5 questions21to22 screen6 questions22Contto23 screen7 question24A question24B questions25TO27 question28 questions29TO30 question31 screen15 questions32TO33 questions34TO35 question35CONT question36 questions37to38 questions39to44 question45 questions46to47 question47Cont questions48to49 ExtraPage SCREEN1 JOB TITLE Background Extra Paper SCREEN1 Background Extra Paper SCREEN1 Background Extra Paper Extra Paper Page171A SCREEN1 JOB TITLE SCREEN1 SCREEN1 PAGE5 Page171ALong SCREEN1 JOB TITLE 171LONG SCREEN1 171LONG SCREEN1 171LONG 171A LONG1 PreviewPage1 Page1 PreviewPage2 PreviewPage3 PreviewPage4 Return leaveBook susSuspendMessages enterRecordField leaveRecordField keyChar enterRecordField getSystemMetrics video video leaveRecordField keyChar video sysCaretPosition video sysCaretPosition ClearCurrentExtraPage Courier8 leaveBackground Courier9 Courier10 TimesNewRoman8 NextPage TimesNewRoman9 enterBackground TimesNewRoman10 System keyup etPosition sysCaretPosition getCaretLoc enterBackground ExtraPage NextPage ExtraPage ExtraPage &Fonts Courier 8 &Fonts Courier 9 &Fonts Courier 10 &Fonts Times New Roman 8 &Fonts Times New Roman 9 &Fonts Times New Roman 10 &Fonts System &Fonts GetCaretPos GetSystemMetrics tbkwin.dll pageFromClient kernel globalAlloc globalFree globalLock globalUnlock globalAlloc globalLock lpMem leaveBackground ExtraPage &Fonts kernel tbkwin.dll globalUnlock globalFree lpMem NextPage ClearCurrentExtraPage Are you sure? This will clear your current ExtraPage. additional work item number Courier8 additional work Courier additional work Courier9 additional work Courier additional work Courier10 additional work Courier additional work TimesNewRoman8 additional work Times New Roman additional work TimesNewRoman9 additional work Times New Roman additional work TimesNewRoman10 additional work Times New Roman additional work System additional work System sysCaretPosition GetCaretPos pageFromClient lpMem getCaretLoc sysCaretPosition textfrompoint keyup getCaretLoc PAGE5 EXTRA PAPER enterPage leavePage enterPage Clear Current ExtraPage &Clear leavePage ExtraPage Clear Current ExtraPage Current ExtraPage &Clear leavePage ExtraPage Clear Current ExtraPage 7/29/93 Courier8 Courier9 LeaveBackground Courier10 TimesNewRoman8 TimesNewRoman9 NextPage TimesNewRoman10 EnterBackground System ClearCurrent171A keyup etPosition sysCaretPosition getCaretLoc EnterBackground ExtraPage NextPage ExtraPage ExtraPage &Fonts Courier 8 &Fonts Courier 9 &Fonts Courier 10 &Fonts Times New Roman 8 &Fonts Times New Roman 9 &Fonts Times New Roman 10 &Fonts System &Fonts GetCaretPos GetSystemMetrics tbkwin.dll pageFromClient kernel globalAlloc globalFree globalLock globalUnlock globalAlloc globalLock lpMem LeaveBackground ExtraPage &Fonts kernel tbkwin.dll globalUnlock globalFree lpMem NextPage Courier8 description3 Courier description3 Courier9 description3 Courier description3 Courier10 description3 Courier description3 TimesNewRoman8 description3 Times New Roman description3 TimesNewRoman9 description3 Times New Roman description3 TimesNewRoman10 description3 Times New Roman description3 System description3 System ClearCurrent171A Are you sure? This will clear your current 171A page (Long form). DESCRIPTION3 raddress supervisor job title promotion date leaving employees ending starting address2 BLOCK1 sysCaretPosition GetCaretPos pageFromClient lpMem getCaretLoc sysCaretPosition textfrompoint keyup getCaretLoc BACKGROUND1 TERPAGE LEAVEPAGE ENTERPAGE CurrentUsers ENTERPAGE Current Users Limit Current Users &Help Name1 Name1 Name2 Name2 Name3 Name3 Name4 Name4 Name5 Name5 Name6 Name6 Name7 Name7 Name8 Name8 LEAVEPAGE SCREEN1 PAGE1 SCREEN1 PAGE1 SCREEN1 PAGE1 SCREEN1 PAGE1 SCREEN1 PAGE1 SCREEN1 PAGE1 ADDRESS SCREEN1 ADDRESS PAGE1 SCREEN1 PAGE1 STATE PAGE1 STATE2 PAGE1 PAGE1 PAGE1 PAGE1 PAGE1 PAGE1 CHECKED PAGE1 PAGE1 FEMALE CHECKED PAGE1 PAGE1 Current Users Current Users STATE CurrentUsers Current Users BUTTONUP 0BUTTONUP PAGE1 PAGE1 PAGE1 PAGE1 PAGE1 PAGE1 PAGE1 PAGE1 TO DATE PAGE1 FROM DATE PAGE1 HIGHEST JOB PAGE1 START WORK PAGE1 PAGE1 PAGE1 GRADE PAGE1 PAGE1 14AYES PAGE1 14ANO PAGE1 14BYES PAGE1 14BNO PAGE1 14CYES PAGE1 14CNO PAGE1 14DYES PAGE1 14DNO PAGE1 14EYES PAGE1 14ENO PAGE1 14FYES PAGE1 14FNO PAGE1 15AYES PAGE1 15ANO PAGE1 15BYES PAGE1 15BNO PAGE1 15CYES PAGE1 15CNO PAGE1 16AYES PAGE1 16ANO PAGE1 16BYES PAGE1 16BNO PAGE1 16CYES PAGE1 16CNO PAGE1 17YES PAGE1 PAGE1 18YES PAGE1 PAGE1 19YES PAGE1 PAGE1 DISCHARGE DATE PAGE1 TYPE DISCHARGE PAGE1 20FROM PAGE1 PAGE1 20SERVICE PAGE1 20FROM2 PAGE1 20TO2 PAGE1 20SERVICE2 PAGE1 SCREEN6 PAGE1 22PREF PAGE1 PAGE1 PAGE1 PAGE1 PAGE1 23YES PAGE2 PAGE2 PAGE2 24AVERAGE PAGE2 24EMPLOYEES PAGE2 24FROM PAGE2 PAGE2 24LEAVE PAGE2 24TITLE PAGE2 24STARTING PAGE2 24ENDING PAGE2 PERSTARTING PAGE2 PERENDING PAGE2 SUPERVISOR PAGE2 24AREA PAGE2 24PHONE PAGE2 DATE PROMOTION PAGE2 24DESCRIP PAGE2 PAGE2 24BAVERAGE PAGE2 24BEMPLOYEES PAGE2 24BFROM PAGE2 24BTO PAGE2 24BLEAVE PAGE2 24BTITLE PAGE2 24BSTARTING PAGE2 24BENDING PAGE2 24B PERENDING PAGE2 24BSUPERVISOR PAGE2 24BAREA PAGE2 24BPHONE PAGE2 24BPROMOTION PAGE2 24BWORK PAGE2 25YES PAGE3 PAGE3 27YES PAGE3 PAGE3 25GED PAGE3 25GRADE PAGE3 PAGE3 28NAME1 PAGE3 28NAME2 PAGE3 28NAME3 PAGE3 28CITY1 PAGE3 28CITY2 PAGE3 28CITY3 PAGE3 28STATE1 PAGE3 28STATE2 PAGE3 28STATE3 PAGE3 28ZIP1 PAGE3 28ZIP2 PAGE3 28ZIP3 PAGE3 28FROM1 PAGE3 28FROM2 PAGE3 28FROM3 PAGE3 28TO1 PAGE3 28TO2 PAGE3 28TO3 PAGE3 PAGE3 PAGE3 PAGE3 PAGE3 PAGE3 PAGE3 TYPE1 PAGE3 TYPE2 PAGE3 TYPE3 PAGE3 DEGREE1 PAGE3 DEGREE2 PAGE3 DEGREE3 PAGE3 UNDERGRAD1 PAGE3 UNDERGRAD2 PAGE3 UNDERGRAD3 PAGE3 29SEM1 PAGE3 29SEM2 PAGE3 29SEM3 PAGE3 PAGE3 PAGE3 PAGE3 GRADUATE1 PAGE3 GRADUATE2 PAGE3 GRADUATE3 PAGE3 31SCHOOL1 PAGE3 31CITY1 PAGE3 31SCHOOL2 PAGE3 31CITY2 PAGE3 31STATE1 PAGE3 31ZIP1 PAGE3 31STATE2 PAGE3 31ZIP2 PAGE3 31SUBJ1 PAGE3 31SUBJ2 PAGE3 31FROM PAGE3 PAGE3 31FROM2 PAGE3 31TO2 PAGE3 PAGE3 PAGE3 PAGE3 PAGE3 PAGE3 PAGE3 31TYES1 PAGE3 31TNO1 PAGE3 31TYES2 PAGE3 31TNO2 PAGE3 PAGE3 35YES PAGE3 PAGE3 34LICENSE1 PAGE3 34LICENSE2 PAGE3 34DATE1 PAGE3 34DATE2 PAGE3 34STATE1 PAGE3 34STATE2 PAGE3 35LANG1 PAGE3 35LANG2 PAGE3 LECTF1 PAGE3 LECTF2 PAGE3 LECTD1 PAGE3 LECTD2 PAGE3 SPEAKF1 PAGE3 SPEAKF2 PAGE3 SPEAKP1 PAGE3 SPEAKP2 PAGE3 35INTO1 PAGE3 35INTO2 PAGE3 35FROM1 PAGE3 35FROM2 PAGE3 READE1 PAGE3 READE2 PAGE3 READD1 PAGE3 READD2 PAGE3 36NAMEA PAGE3 36PHONEA PAGE3 36STA PAGE3 36NAMEB PAGE3 36PHONEB PAGE3 36STB PAGE3 36NAMEC PAGE3 36PHONEC PAGE3 36STC PAGE3 36ZIPA PAGE3 36ZIPB PAGE3 36ZIPC PAGE3 36ADDRESS1 PAGE3 36ADDRESS2 PAGE3 36ADDRESS3 PAGE3 37YES PAGE4 PAGE4 38YES PAGE4 PAGE4 37COUNTRY SCREEN20 39YES PAGE4 PAGE4 40YES PAGE4 PAGE4 41YES PAGE4 PAGE4 42YES PAGE4 PAGE4 43YES PAGE4 PAGE4 44YES PAGE4 PAGE4 ITEM1 PAGE4 45DATE1 PAGE4 45EXP1 PAGE4 45NAME1 PAGE4 45CITY1 PAGE4 45ST1 PAGE4 45ZIP1 PAGE4 ITEM2 PAGE4 45DATE2 PAGE4 45EXP2 PAGE4 45NAME2 PAGE4 45CITY2 PAGE4 45ST2 PAGE4 45ZIP2 PAGE4 46YES SCREEN23 SCREEN23 47YES SCREEN23 SCREEN23 47NAMEA PAGE4 PAGE4 PAGE4 47NAMEB PAGE4 PAGE4 PAGE4 47NAMEC PAGE4 PAGE4 PAGE4 49DATE PAGE4 BUTTON BUTTONUP XNBUTTONUP USERNUMBER USERLIMIT1 name1 name1 name1 screen1 NAME1 Limit Limit name1 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. USERNUMBER USERLIMIT2 name1 name2 name1 name2 name1 screen1 name2 name1 name2 NAME1 NAME2 Limit Limit name1 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. name2 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. USERNUMBER USERLIMIT3 name1 name2 name3 name1 name2 name3 name1 screen1 name2 name1 name3 name2 name3 name1 name2 name3 NAME1 UPPER UPPER NAME2 UPPER UPPER NAME3 UPPER Limit Limit name1 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. name2 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. name3 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. USERNUMBER USERLIMIT8 name1 name2 name3 name4 name5 name6 name7 name8 name1 name2 screen1 name3 screen1 name4 screen1 name5 screen1 name6 screen1 name7 screen1 name8 screen1 screen1 name1 screen1 screen1 name2 name1 screen1 name3 screen1 name4 name5 name6 name7 name8 screen1 name2 screen1 name3 name1 screen1 name2 screen1 name4 name5 name6 name7 name8 screen1 name3 screen1 name4 name1 name2 name3 name5 name6 name7 name8 screen1 name4 screen1 name5 name1 name2 name3 name4 name6 name7 name8 screen1 name5 screen1 name6 name1 name2 name3 name4 name5 name7 name8 screen1 name6 screen1 name7 name1 name2 name3 name4 name5 name6 name8 screen1 name7 screen1 name8 name1 name2 name3 name4 name5 name6 name6 name6 name7 screen1 name8 screen1 NAME1 NAME2 NAME3 NAME4 NAME5 NAME6 NAME7 NAME8 Limit Limit name1 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 1 name2 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 2 name3 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 3 name4 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 4 name5 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 5 name6 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 6 name7 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 7 name8 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 8 171A LONG1 171A LONG10 Background Extra Paper ADDITIONAL WORK EXPERIENCE BLOCKS 1. Name (Last, First, Middle Initial) 3. Job Title or Announcement Number You Applying For 2. Social Security Number 4. Date Completed Number ADDITIONAL WORK JOB TITLE item number ecordField enterRecordField LeaveRecordField enterRecordField LeaveRecordField LeaveRecordField SCREEN4 PAGE7 PAGE9 PAGE14 EXTRAPAPER4 BUTTONUP {NBUTTONUP USERNUMBER USERLIMIT1 name1 name1 name1 screen1 NAME1 Limit Limit name1 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. USERNUMBER USERLIMIT2 name1 name2 name1 name2 name1 screen1 name2 name1 name2 NAME1 NAME2 Limit Limit name1 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. name2 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. USERNUMBER USERLIMIT3 name1 name2 name3 name1 name2 name3 name1 screen1 name2 name1 name3 name2 name3 name1 name2 name3 NAME1 UPPER UPPER NAME2 UPPER UPPER NAME3 UPPER Limit Limit name1 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. name2 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. name3 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. USERNUMBER USERLIMIT8 name1 name2 name3 name4 name5 name6 name7 name8 name1 name2 screen1 name3 screen1 name4 screen1 name5 screen1 name6 screen1 name7 screen1 name8 screen1 screen1 name1 screen1 screen1 name2 name1 screen1 name3 screen1 name4 name5 name6 name7 name8 screen1 name2 screen1 name3 name1 screen1 name2 screen1 name4 name5 name6 name7 name8 screen1 name3 screen1 name4 name1 name2 name3 name5 name6 name7 name8 screen1 name4 screen1 name5 name1 name2 name3 name4 name6 name7 name8 screen1 name5 screen1 name6 name1 name2 name3 name4 name5 name7 name8 screen1 name6 screen1 name7 name1 name2 name3 name4 name5 name6 name8 screen1 name7 screen1 name8 name1 name2 name3 name4 name5 name6 name6 name6 name7 screen1 name8 screen1 NAME1 NAME2 NAME3 NAME4 NAME5 NAME6 NAME7 NAME8 Limit Limit name1 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 1 name2 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 2 name3 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 3 name4 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 4 name5 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 5 name6 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 6 name7 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 7 name8 screen1 screen1 InCorrect SS Number...Exiting System ! Try running SF171 and try again. 8 button SCREEN5 EXTRAPAPER5 PAGE15 SCREEN7 SCREEN9 SCREEN14 EXTRAPAPER7 PAGE17 EXTRAPAPER9 PAGE19 LEAVEPAGE ENTERPAGE LEAVEPAGE button SCREEN2 PAGE1 SCREEN2 PAGE1 SCREEN2 PAGE1 SCREEN2 PAGE1 SCREEN2 PAGE1 HIGHEST JOB SCREEN2 HIGHEST JOB PAGE1 FROM DATE SCREEN2 FROM DATE PAGE1 TO DATE SCREEN2 TO DATE PAGE1 START WORK SCREEN2 START WORK PAGE1 CHECKED PAGE1 PAGE1 CONDITIONAL CHECKED CONDITIONAL PAGE1 CONDITIONAL PAGE1 CAREER CHECKED CAREER PAGE1 CAREER PAGE1 EXPECTED CHECKED EXPECTED PAGE1 EXPECTED PAGE1 ENTERPAGE ENTERPAGE LEAVEPAGE ENTERPAGE LEAVEPAGE button SCREEN3 PAGE1 SCREEN3 PAGE1 GRADE SCREEN3 GRADE PAGE1 SCREEN3 PAGE1 14AYES CHECKED 14AYES PAGE1 14AYES PAGE1 14ANO CHECKED 14ANO PAGE1 14ANO PAGE1 14BYES CHECKED 14BYES PAGE1 14BYES PAGE1 14BNO CHECKED 14BNO PAGE1 14BNO PAGE1 14CYES CHECKED 14CYES PAGE1 14CYES PAGE1 14CNO CHECKED 14CNO PAGE1 14CNO PAGE1 14DYES CHECKED 14DYES PAGE1 14DYES PAGE1 14DNO CHECKED 14DNO PAGE1 14DNO PAGE1 14EYES CHECKED 14EYES PAGE1 14EYES PAGE1 14ENO CHECKED 14ENO PAGE1 14ENO PAGE1 14FYES CHECKED 14FYES PAGE1 14FYES PAGE1 14FNO CHECKED 14FNO PAGE1 14FNO PAGE1 !*"P"v" ,2-z- .8/x/ /80|0 4&5h5B7r8 ADDITIONAL WORK EXPERIENCE BLOCKS Average number of Name and address of employer's organization (including ZIP Code, if known) Dates employed (give month, day and year) hours per week Number of employees you supervised From: To::::: Salary or earnings Your reason for leaving to leave Starting $ perrrrrr Ending $ perrrrrrr U#B U# n(B n(1 Your immediate supervisor Area Code Telephone No. Exact title of your job If Federal employment (civilian or military) list series, grade orr rank, and, if promoted in this job, the date of your last promotionnb, the date of your last promotion Description of work: Describe your specific duties, responsibilities and accomplishments in this job, including the job title(s) of any employees you supervised. 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. .;_..; Average number of Name and address of employer's organization (including ZIP Code, if known) Dates employed (give month, day and year) hours per week (\",. Number of employees ",.-$ you supervise From: To::::::::: Salary or earnings Your reason for leaving to leave %t"X& Starting $ perrrrrrrrrrr Ending $ perrrrrrrrrrrr *',.*' Z$,.Z$ *'~ e( Your immediate supervisor Area Code Telephone No. Exact title of your job ):/&+ Description of work: Describe your specific duties, responsibilities and accomplishments in this job, including the job title(s) of any employees you supervised. 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. %#O A.\" Y.3 : U#$ X$H! %#O A.G! #O 3. For Agency Use (skill codes, etc.) %#8!*$\" ~!6!{! Standard Form 171-A Continuation Sheet for SF 171 Attach all SF 171-A's to your application at the top of page 3..'" 1. Name (Last, First, Middle Initial) 3. Job Title or Announcement Number You Are Applying For Z$2$W$ 2. Social Security Number 4. Date Completed %l*v OMB No. 3206-001222 No. 3206-0012 Form Approved: OMB No. 3206-0012 THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER h' 'e' PREVIOUS EDITION USABLE UNTIL 12-31-90ORTUNITY EMPLOYER ;I/]< Standard Form 171-A (Rev. 6-88) U.S. Office of Personnel Management FPM Chapter 295 DESCRIPTION b)test +;.u9 DESCRIPTION2 SUPERVISOR F*test JOB TITLE ecordField enterRecordField leaveRecordField enterRecordField leaveRecordField -eaveRecordField PROMOTION DATE LEAVING ecordField enterRecordField leaveRecordField enterRecordField leaveRecordField /eaveRecordField JOB TITLE rAddress ecordField enterRecordField leaveRecordField enterRecordField leaveRecordField eaveRecordField employees STARTING ENDING Address2 SUPERVISOR2 AREA2 TELE2 JOB TITLE2 PROMOTION DATE2 starting2 ending2 $7#+& per1b per2b from2 LEAVING2 employees2 BLOCK1 If Federal employment (civilian or military) list series, grade orr rank, and, if promoted in this job, the date of your last promotionnnnnnnnnnnte of your last promotion U#!9Y..; K.} J8U#$ X$H! U#!9Y. $!9K.c: For Agency Use (skill codes, etc.) :X$.; BLOCK2 video PAGE5 PAGE1 enterPage leavePage enterPage Clear Current 171A &Clear leavePage ExtraPage Clear Current 171A Clear Current 171A &Clear leavePage ExtraPage Clear Current 171A jghkhjkh SCREEN5 :PHYSSIZE :PHYSSIZE BUTTONUP BUTTONUP BUTTONUP :PHYSSIZE BUTTONUP BUTTONUP BUTTONUP BUTTONUP BUTTONUP BUTTONUP Items 19-20 Items 19-20 19. Were you discharged from the military service under honorable conditions?bs which (If your discharge was changed to "honorable" or "general" by a Discharge Discharge Date (Month, Day, Year) Type of Dischargeeeeeeargejobs which 20. List the dates (Month, Day, Year), and branch for all active duty military service. From To Branch of Serviceeeeeeeeeeeeeeeeeeh provide below the date and type of discharge you received. 19YES buttonUp buttonUp 19YES 19YES DISCHARGE DATE buttonUp 19YES 19YES DISCHARGE DATE buttonUp buttonUp 19yes 19yes DISCHARGE DATE uttonUp 19yes 19yes DISCHARGE DATE DISCHARGE DATE TYPE DISCHARGE Review Board, answer "YES". If you received a clemency discharge, answer "NO". If "NO",, 20FROM 20SERVICE 20FROM2 20TO2 20SERVICE2 SCREEN3 #<$l% )6*f+ :PHYSSIZE :PHYSSIZE BUTTONUP BUTTONUP BUTTONUP :PHYSSIZE BUTTONUP BUTTONUP BUTTONUP BUTTONUP BUTTONUP BUTTONUP Items 12-14 Items 12-14 12. What is the lowest pay you will accept? (you will not be considered for jobs which Pay $ GRADE pay less than you indicate.) OR Grade 13. In what geographic area(s) are you willing to work??t be considered for jobs which 14. Are you willing to work:(s) are you willing to work?t be considered for jobs which 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. An intermittent job (on-call/seasonal)?..................... 14AYES buttonUp buttonUp 14ayes 14ano 14ayes 14ano buttonUp 14ayes 14ano 14ayes 14ano 14BYES buttonUp buttonUp 14byes 14bno 14byes 14bno uttonUp 14byes 14bno 14byes 14bno 14ANO buttonUp buttonUp 14ano 14ayes 14ano 14ayes tonUp 14ano 14ayes 14ano 14ayes 14BNO buttonUp buttonUp 14bno 14byes 14bno 14byes "tonUp 14bno 14byes 14bno 14byes L!$!I! 14CYES buttonUp buttonUp 14cyes 14cno 14cyes 14cno #uttonUp 14cyes 14cno 14cyes 14cno 14DYES buttonUp buttonUp 14dyes 14dno 14dyes 14dno buttonUp 14dyes 14dno 14dyes 14dno 14CNO buttonUp buttonUp 14cno 14cyes 14cno 14cyes #<&tonUp 14cno 14cyes 14cno 14cyes 14DNO buttonUp buttonUp 14dno 14dyes 14dno 14dyes %n'tonUp 14dno 14dyes 14dno 14dyes 14EYES buttonUp buttonUp 14eyes 14eno 14eyes 14eno buttonUp 14eyes 14eno 14eyes 14eno 14FYES buttonUp buttonUp 14fyes 14fno 14fyes 14fno )uttonUp 14fyes 14fno 14fyes 14fno 14ENO buttonUp buttonUp 14eno 14eyes 14eno 14eyes +tonUp 14eno 14eyes 14eno 14eyes 14FNO buttonUp buttonUp 14fno 14fyes 14fno 14fyes tonUp 14fno 14fyes 14fno 14fyes F. Weekends, shifts, or rotating shifts?..................... SCREEN4 #($^% '4(d)H*,+ +f,r. /R0`1 3>425d:,; :PHYSSIZE :PHYSSIZE BUTTONUP BUTTONUP BUTTONUP :PHYSSIZE BUTTONUP BUTTONUP BUTTONUP BUTTONUP BUTTONUP BUTTONUP Items 15-18 Items 15-18 15. Are you willing to take a temporary job lasting:l not be considered for jobs which 16. Are you willing to travel away from home for:o work?t be considered for jobs which 17. Have you served in the United States Military Service? If yourered for jobs which A. 5 to 12 months (sometimes longer)?................................................................ B. 1 to 4 months?......................................................................................... C. Less than 1 month?................................................................................. 15BYES buttonUp buttonUp 15byes 15bno 15byes 15bno uttonUp 15byes 15bno 15byes 15bno 15CYES buttonUp buttonUp 15cyes 15cno 15cyes 15cno uttonUp 15cyes 15cno 15cyes 15cno 15ANO buttonUp buttonUp 15ano 15ayes 15ano 15ayes tonUp 15ano 15ayes 15ano 15ayes 15BNO buttonUp buttonUp 15bno 15byes 15bno 15byes tonUp 15bno 15byes 15bno 15byes 15CNO buttonUp buttonUp 15cno 15cyes 15cno 15cyes P#tonUp 15cno 15cyes 15cno 15cyes 18. Did you or will you retire at or above the rank of major or lieutenant............. only active duty was training in the Reserves or National Guard, answer "NO". If "NO", go to item 22 ................................................................. 16BYES buttonUp buttonUp 16byes 16bno 16byes 16bno $uttonUp 16byes 16bno 16byes 16bno 16CYES buttonUp buttonUp 16cyes 16cno 16cyes 16cno bZ%P#.& buttonUp 16cyes 16cno 16cyes 16cno 16ANO buttonUp buttonUp 16ano 16ayes 16ano 16ayes $^'tonUp 16ano 16ayes 16ano 16ayes 16BNO buttonUp buttonUp 16bno 16byes 16bno 16byes )tonUp 16bno 16byes 16bno 16byes 16CNO buttonUp buttonUp 16cno 16cyes 16cno 16cyes -tonUp 16cno 16cyes 16cno 16cyes A. 1 to 5 nights each month?............................................................................................ B. 6 to 10 nights each month?...................................................................... C. 11 or more nights each month?................................................................ V,.,S, buttonUp buttonUp 17yes You have selected 'NO' for question 17. would you like to proceed to question 22? screen6 buttonUp buttonUp 17yes You have selected 'NO' for question 17. would you like to proceed to question 22? screen6 18YES buttonUp buttonUp B"18no" buttonUp buttonUp buttonUp buttonUp 18yes %\1n/ buttonUp buttonUp 18yes 15AYES buttonUp buttonUp 15ayes 15ano 15ayes 15ano 3uttonUp 15ayes 15ano 15ayes 15ano 16AYES buttonUp buttonUp 16ayes 16ano 16ayes 16ano 4uttonUp 16ayes 16ano 16ayes 16ano 17YES buttonUp buttonUp B"17no" buttonUp buttonUp 9:PHYSSIZE T:,:Q: Jump to 22 JUMP TO 22 BUTTONUP BUTTONUP SCREEN6 BUTTONUP SCREEN6 commander .................................................................................................. SCREEN6 ENTERPAGE LEAVEPAGE ENTERPAGE LEAVEPAGE button SCREEN6 PAGE1 CHECKED PAGE1 PAGE1 22PREF CHECKED 22PREF PAGE1 22PREF PAGE1 ENTERPAGE LEAVEPAGE ENTERPAGE LEAVEPAGE button SCREEN6 PAGE1 CHECKED PAGE1 PAGE1 22PREF CHECKED 22PREF PAGE1 22PREF PAGE1 ^ :PHYSSIZE :PHYSSIZE BUTTONUP BUTTONUP BUTTONUP :PHYSSIZE BUTTONUP BUTTONUP BUTTONUP BUTTONUP BUTTONUP BUTTONUP Items 21-22 Items 21-22 21. If all your active military duty was after October 14, 1976, list the full names and dates of all campaign badges or expeditionary medals you received or were entitled to receive. 22. Read the instructions that came with this form before completing thislitary service. instructions, place an "X" in the box next to your veteran preference claim. item. When you have determined your eligibility for veteran preference from the 22PREF NO PREFERENCE 5-POINT PREFERENCE -- You must show proof when you are hired.. SCREEN7 LEAVEPAGE LEAVEPAGE button CHECKED PAGE1 PAGE1 CHECKED PAGE1 PAGE1 CHECKED PAGE1 PAGE1 CHECKED PAGE1 PAGE1 22D" OF LEAVEPAGE LEAVEPAGE button CHECKED PAGE1 PAGE1 CHECKED PAGE1 PAGE1 CHECKED PAGE1 PAGE1 CHECKED PAGE1 PAGE1 :PHYSSIZE :PHYSSIZE TO HANDLE BUTTONUP BUTTONUP BUTTONUP :PHYSSIZE BUTTONUP BUTTONUP BUTTONUP BUTTONUP BUTTONUP BUTTONUP Items 22 Continued - 23 Items 22 Continued - 23 Non-compensably disabled or Purple Heart recipient. Compensably disabled, less than 30 percent. Spouse, widow(er), or mother of a deceased or disabled veteran. Compensably disabled, 30 percent or more an "X" in the box next to your veteran preference claim. X R 10-POINT PREFERENCE -- If you claim 10-point preference, place an "X" in the box below next to the basis for your claim. To receive 10-point preference, you must also complete a Standard Form 15, Application for 10-point Veteran Preference, which is available from any Federal Job Information Center. ATTACH THE COMPLETED SF 15 AND REQUESTED PROOF TO THIS APPLICATION. 22. Read the instructions that came with the form before completing this item. When you have determined your eligibility for veteran preference from the instructions, place System :PRINTLAYOUT Arial Arial Arial System Arial Times New Roman Arial Arial Arial Arial Arial Arial Arial Arial Arial Arial Arial nScenario SF171 for Windows mes New Roman Times New Roman Times New Roman Times New Roman mes CG ATT Arial Arial Arial Times New Roman Times New Roman Wingdings Arial Arial urier mes New Roman Times New Roman urier urier w Roman c:\docs\toolbook\sf171.ico reader SCREEN1 SCREEN1 SCREEN1 SCREEN1 SCREEN1 SCREEN1 ADDRESS SCREEN1 SCREEN1 STATE SCREEN1 SCREEN1 PAGE1 PAGE1 PAGE1 PAGE1 PAGE1 Times New Roman Times New Roman Times New Roman Times New Roman Times New Roman Times New Roman Times New Roman System mes New Roman mes New Roman Times New Roman mes New Roman <".f; Arial Times New Roman mes New Roman nAydtwsxAt mes New Roman ngdings mes New Roman WinScenario SF171 for Windows urier New ngdings Arial mes New Roman mes New Roman mes New Roman mes New Roman &Clear Clear &all pages &Clear &Import... &Export... Select Page &Help &SF171 Help &Help &Home &Help c:\docs\toolbook\sf171.ico reader sizetoPage ClearallPages leaveBook BACKGROUND1 EnterPage EnterPage BUTTON EnterPage BUTTON "v#T% :PHYSSIZE To Print All Pages To Begin Filling out Your SF 17111111111111111111111 :PHYSSIZE :PHYSSIZE PRINT BUTTONUP BUTTONUP PAGE1 TTONUP BUTTONUP PAGE1 PRINT BUTTONUP BUTTONUP SCREEN1 BUTTONUP SCREEN1 To Open a:Pages 1-44 SF 171-Aa:Pages 1-44 Blank Sheet of Paper :PHYSSIZE BUTTONUP BUTTONUP SCREEN1 JOB TITLE SCREEN1 SCREEN1 PAGE5 BUTTONUP SCREEN1 JOB TITLE SCREEN1 SCREEN1 PAGE5 :PHYSSIZE BUTTONUP BUTTONUP SCREEN1 JOB TITLE Background Extra Paper SCREEN1 Background Extra Paper SCREEN1 Background Extra Paper Extra Paper Extra Paper JOB TITLE Background Extra Paper SCREEN1 Background Extra Paper SCREEN1 Background Extra Paper Extra Paper Extra Paper WinScenario SF 171 v 1.0dd v 0.9ccc Click A Button:: d"Z"a" You are now at the HOME Screen. You can click this button when you see it, to return to this screen. BUTTONUP BUTTONUP SCREEN1 JOB TITLE 171LONG SCREEN1 171LONG SCREEN1 171LONG 171A LONG1 BUTTONUP SCREEN1 JOB TITLE 171LONG SCREEN1 171LONG SCREEN1 171LONG 171A LONG1 This button will send you back 1 screen. p&(&m& This button will send you forward 1 screen. Tiny Instructions WinScenario is a trademark of HJ Ford. 1993 HJ Ford Associates Incorporatedd ,:PHYSSIZE *1:PHYSSIZE 5:PHYSSIZE Info... For More buttonup buttonup @tonup z:R:w: HJ Ford Welcomes You To n,@Nv h@:PHYSSIZE buttonup buttonup zARAwA WinScenario SF 1711 was created by: Martin Charles Tim Demarest 1111 Jefferson Davis Highway Suite 808 Arlington, VA 22202 (800) 873-3470 H FORDDD ASSOCIATES INCORPORATED rEJEoE 1993 HJ Ford Associates Incorporated - A product of The Quality Spirit Teammmtes Incorporated - A product of The Quality Spirit Team All Rights Reserved. forth in subparagraph (c)(1)(ii) of the Rights in Technical Data and Computero This software is a licensed, published work under the copyright laws of the United Statess and foreign countries. Use, disassembly, and reproduction of this software is restricted by U.S. Government Restricted Rights. Use, duplication, or disclosure by the Government is subject to worldwide copyright laws. 1992 Asymetrix Corp.(Portions of this product) All rights reserved. restrictions as set forth in subparagraph (c)(1)(ii) of the Rights in Technical Data and Computero Software clause at DFARS 252.227-7013 (Oct. 1988) and FAR 52.227 - 19 (June 1987)Data and Computero For Windows agreement NOTICE: Under no condition may this product be sold, modified, copied, or distributed to third parties. HJ Ford Associates Inc. reserves all rights under Federal copyright law. Use, disassembly, and reproduction of this software is restricted by your license (contained in the package) and by world copyright laws. ToolBook Runtime Files are copyrighted products of Asymetrix Corporation, Bellevue, WA. Use, duplication, or disclosure by the U.S. Government is subject to restrictions as set forth in subparagraph (c) (1) (ii) of the Rights in Technical Data and Computer Software clause at DFARS 252.227-7013 (October 1988) and FAR 52.227-19 (June 1987) . Please indicate your acceptance of the above terms and conditions by selecting "YES" below. Selecting "NO" will cause you to exit this program. BUTTONUP BUTTONUP RegUser agreement BUTTONUP RegUser agreement Register DISAGREE BUTTONUP BUTTONUP BUTTONUP buttonUp buttonUp reguser You must register this to continue! Agreement You must register this to continue! Agreement agreement2 RegUser Your Name The following question will personalize this copy of the SF171 with the name of the registered owner of this software. Would you like to personalize your software now??? buttonUp buttonUp RegUser What is your name? Your Name reguser nrZ>V [uttonUp RegUser What is your name? Your Name reguser buttonUp buttonUp [:PHYSSIZE user version text n\F\k\ Eight user versionsion button xa:PHYSSIZE ERASE PRINTED PAGE FIELDS? regusertext This software is registered to: $6\eW :Tk~ SECRET NAME1 NAME2 NAME3 secret CHECKED buttonUp buttonUp name1 name2 name3 name1 name2 name3 USERNUMBER NAME4 NAME5 NAME6 NAME7 NAME8 USERLIMIT1 USERLIMIT2 USERLIMIT3 USERLIMIT8 !DEMO VERSION ONLY! To Order: Call 1-800-873-3470/ )>)t)8* >&>L>r> D4DZD E2FXF HhI,J PHQnQ SHTnT ]8``` b4bZb d*dPdvd f@fhf sDtjt w,xTx xTy|y y>zdz {0|f| DO NOT WRITE IN THIS AREA Agency 10-POINT PREFERENCE -- If you claim 10-point preference, place an "X""""""""""""""""""""""""" NSN 7540-00-935-7150 171-110 EMPLOYER ~'l9g/ Standard Form 171 (Rev. 6-88) in the box below next to the basis for your claim. To receive 10-pointttttttttttttttttt 2U/Z3 preference you must also complete a Standard Form 15, Application for 10-Point Veteran Preference, which is available from any Federal N3y/z4 Job Information Center. ATTACH THE COMPLETED SF 15 ANDD REQUESTED PROOF TO THIS APPLICATION. 5m);7 Non-compensably disabled or Purple Heart recipient............ Compensably disabled, less than 30 percent. Spouse, widow(er), or mother of a deceased or disabled veteran.. Compensably disabled, 30 percent or more. {*v V {*)" !M+F# .j 00 !b%3$ ._(,% -R&R%/ .Q'x%8 ._ ^& List the dates (Month, Day, Year) and branch for all active duty military service. MILITARY SERVICE AND VETERAN PREFERENCE (Cont.) Were you discharged from the military service under honorable conditions? (If your discharge was changed to "honorable" or "general" by a Discharge Review Board, answer "YES". If you received a clemency discharge, answer "NO".) If "NO", provide below the date and type of discharge you received. Discharge Date !k+7# Type of Discharge (Month, Day, Year) all campaign badges or expeditionary medals you received or were entitled to receive. Read the instructions that came with this form before completing this item. When you have determined your eligibility for veteran preference from the instruc- ---J. tions, place an "X" in the box next to your veteran preference claim. NO PREFERENCE 5-POINT PREFERENCE -- You must show proof when you are hired. !S%Q$ $X$}$ Branch of Service P().P( B').B' *P ,.P `'8']' U.S. Office of Personnel Management l(D(i( FPM Chapter 295 A. 1 to 5 nights each month?. . . . . . . . . . . . . . . . . . . . . . . . . . . . A. 5 to 12 months (sometimes longer)?. . . . . . . . . . . . . . answer "NO". If "NO", go to item 22. . . . . . . . . . . . . . . . . . . . . . . . .. ant commander?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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. An intermittent job (on-call/seasonal)?. . . . . . . . . .... F. Weekends, shifts, or rotating shifts?. . . . . . . . . . . . . . If all your active military duty was after October 14, 1976, list the full names and dates of Application for Federal Employment - SF 171 Read the instructions before you complete this application. Type or print clearly in dark ink.. Read the instructions before you complete this application. Type or print clearly in dark ink. OMB No. 3206-001222 No. 3206-0012 Form Approved: OMB No. 3206-0012 GENERAL INFORMATION What kind of job are you applying for? Give title and announcement no. (if any) Birth date (Month, Day, Year) Name (Last, First, Middle)ar) ;X;}; Mailing address (include apartment number, if any)) City))))))))))))))))))))))ar) T=,=Q= State ZIP Code Female Birthplace (City and State or Country)) Social Security Number Item 11. If "YES", mark each type of job you held with an "X". What is your highest grade, classification series and job title?? Other names ever used (e.g., maiden name, nickname, etc))))))))))))))) Home Phone Work Phoneee GXG}G Area Code Area Code lHDHiH Number Number XI0IUI Extension Were you ever employed as a civilian by the Federal Government? if "NO", go to Temporary Career-Conditional ~KVK{K Career-Conditional Dates at highest grade: FROM TOOOO `M8M]M When can you start work? LN$NIN (Month and Year) What is the lowest pay you will accept? (You will not be considered for jobs which pay less xPPPuP than you indicated.) Pay $____________ per _________ OR Grade ______ jR"RgR In what geographic area(s) are you willing to work? Are you willing to work: |STSyS Excepted B. 6 to 10 nights each month?. . . . . . . . . . . . . . . . . . .... pU(UmU Are you willing to take a temporary job lasting: B. 1 to 4 months?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . C. Less than 1 month?. . . . . . . . . . . . . . . . . . . . . . . . . Are you willing to travel away from home for:ng: C. 11 or more nights each month?. . . . . . . . . . . . . . . .. hY@YeY Have you served in the United States Military Service? If your only active duty was training in the Reserves or National Guard, Did you or will you retire at or above the rank of major or lieuten- h\ \e\ THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER PREVIOUS EDITION USABLE UNTIL 12-31-90ORTUNITY EMPLOYER z]R]w] Page 1 F&z_8 j_B_g_ ba:a_a FOR USE OF EXAMINING OFFICE ONLY Date entered register Ne&eKe Form reviewed: Form approved: Prefernce Preference Signature and Title FOR USE OF APPOINTING OFFICE ONLY Option Grade Earned Rating Veteran plHlml Preference Augmented \m4mYm Rating Claimed Hn nEn 5 Points (Tentative) 10 Pts. (30% Or More 10 Pts. (Less Than 30% Comp. Dis.) Disallowed Other 10 Points Being Investigated Preference has been verified through proof that the separation was under honorable conditions, and other proof as required. 5-Point pvHvmv 10-Point--Other 10-Point--30% or More Compensable Disability Initials and Date 10-Point--Less Than 30% Compensable Disability Comp. Dis.) AVAILABILITY MILITARY SERVICE AND VETERAN PREFERENCE PAGE1 enterPage leavePage enterPage leavePage leavePage ADDRESS HIGHEST JOB FROM DATE START WORK GRADE TO DATE 14AYES 14ANO 14BYES 14BNO 14CYES 14CNO 14DYES 14DNO 14EYES 14ENO 14FYES 14FNO CONDITIONAL CAREER EXPECTED CONDITIONAL CAREER EXPECTED 15AYES 15ANO 15BYES 15CYES 15BNO 15CNO 16AYES 16ANO 16BYES 16BNO 16CYES 16CNO 17YES 18YES 19YES DISCHARGE DATE TYPE DISCHARGE 20FROM 20SERVICE 20FROM2 20TO2 20SERVICE2 ]*=,z+ 22PREF STATE STATE2 PAGE1 SCREEN8 EXTRA PAPER PAGE10 PAGE18 EXTRAPAPER8 SCREEN1 SCREEN10 SCREEN18 PAGE11 EXTRAPAPER10 SCREEN1 :PHYSSIZE :PHYSSIZE Items 1-7 Items 1-7 5. Birthplace (City and State or County)r? Give title and announcement no. (if any) 1. What kind of job are you applying for? Give title and announcement no. (if any) 2. Social Security Numberou applying for? Give title and announcement no. (if any) ADDRESS STATE 4. Birth date (Month, Day, Year)lying for? Give title and announcement no. (if any) 6. Name (Last, First, Middle)ar)lying for? Give title and announcement no. (if any) Mailing Address (including apartment number, if any) State ZIP Code 7. Other names ever used (e.g., maiden name, nickname, etc.)nnouncement no. (if any) 3. Sex Male Femaleerou applying for? Give title and announcement no. (if any) Click on the correct box correct box. buttonUp buttonUp FEMALE FEMALE uttonUp FEMALE FEMALE FEMALE buttonUp buttonUp FEMALE FEMALE FEMALE FEMALE limit User Limit Reached ! Current Users Current SF 171 Users NAME1 NAME2 NAME3 NAME4 NAME5 NAME6 NAME7 NAME8 ButtonUp ButtonUp Current Users Current Users SCREEN2 #"$T$ :PHYSSIZE :PHYSSIZE BUTTONUP BUTTONUP BUTTONUP :PHYSSIZE BUTTONUP BUTTONUP BUTTONUP BUTTONUP BUTTONUP BUTTONUP Items 8-11 Items 8-11 8. Home Phoneof job are you applying for? Give title and announcement no. (if any) Area Code Number 9. Work Phoneof job are you applying for? Give title and announcement no. (if any) HIGHEST JOB FROM DATE TO DATE START WORK Area Code Number Extension What is your highest grade, classification series and job title? Dates at highest grade: FROMification series and job title?tle? 11. When can you start work? (Month and Year)ive title and announcement no. (if any) 10. Were you ever employed as a civilian by the Federal Government? If "NO",, go to Item 11. If "YES", mark each type of job you held with an "X". Click on he correct box the correct Temporary Career-Conditional Career |#T#y# Excepted CONDITIONAL CAREER EXPECTED 171A LONG3 SCREEN2 SCREEN6 SCREEN20 PAGE12 EXTRAPAPER2 PAGE16 EXTRAPAPER6 SCREEN3 PAGE13 EXTRAPAPER3 k{S{k{S{ k{S{k{S{k{ S{k{S{k{S{ k{S{k{S{k{ S{k{S{k{S{ k{S{k{S {k{S{k{S{k {S{k{S{k{S {k{S{k{S{k {S{k{S{k{S {k{S{ {SkS{SkS kS{SkS{Sk S{SkS{SkS{ SkS{SkS{Sk S{SkS k{k{k{k{ k{k{k{k {k{k{k{k{ k{k{k{k{k{ k{k{k{k{ {k{S{k{k{k {S{k{ k{k{k{k{ k{k{k{k{k{ k{k{k {k{k{k{k{ k{k{k{k{k{ {SkS{SkS {SkS{SkS{S kS{SkS{SkS kS{SkS{Sk S{SkS _+S{SkS{S {S{SkS{S{S _+{S{k{S{ k{S{k{S{k{ S{k{S{k{S{ _k{S{k {S{k{S{k{S {k{S{k{S{k {S{k{S{ o_o_o_o_o_ o_o_o _o_o_ o_o_o_o_o_ o_o_o _o_o_ o_o_o_o_o_ o_o_o _o_o_ o_o_o_o_o_ o_o_o _o_o_ o_o_o_o_o_ o_o_o _o_o_ o_o_o_o_o_ o_o_o _o_o_ o_o_o_o_o_ o_o_o _o_o_ o_o_o_o_o_ o_o_o _o_o_ sf171.ico