Are you a citizen of the United States? (In most cases you must be a U.S. citizen to be hired. You will be required to submit proof of identity and citizenship at the time you are hired.) If "NO", give the cB
ountries you are a citizen of:
NOTE: It is important that you give complete and truthful answers to questions 38 through 44. If you answer "YES" to any of them, provide your explanation(s) in Item 45. Include convictions resulting from a pl
ea of nolo contendere (no contest). Omit: 1) traffic fines of $100.00 or less; 2) any violation of law committed before your 16th birthday; 3) any violation of law committed before your 18th birthday, if finC
ally decided in juvenile court or under a Youth Offender law. 4) any conviction set aside under the Federal Youth Corrections Act or similar State law; 5) any conviction whose record was expunged under Federa
l or State law. 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 E
all relevant events or circumstances, this may be grounds for not hiring you, for firing you after you begin work, or for criminal prosecution (18 USC 1001).
During the last 10 years, were you fired from any job for any reason, did you quit after being told that you were fired, or did you leave by mutual agreement because of specific problems?
Have you ever been convicted of, or forfeited collateral for any felony violation? (Generally, a felony is defined as any violation of law punishable by imprisonment of longer than one year, except for violat
Beions called misdemeanors under State law which are punishable by imprisonment of two years or less.)
AbHave you ever been convicted of, or forfeited collateral for any firearms or explosives violation?
A4Are you now under charges for any violation of law?
During the last 10 years have you forfeited collateral, been convicted, been imprisoned, been on probation, or been on parole? Do not include violations reported in 39, 40, or 41, above.
A^Have you ever been convicted by a military court-martial? If no military service, answer "NO"
Are you delinquent on any Federal debt? (Include delinquencies arising from Federal taxes, loans, overpayment of benefits, and other debts to
the U.S. Government plus defaults on Federally guaranteed or insurB2ed loans such as student and home mortgage loans.)
If "YES" in: 38 - Explain for each job the problem(s) and your reason(s) for leaving. Give the employer's name and address.
(Mo./Yr.)
Explanation
Mailing Address
E2Name of Employer, Police, Court, or Federal Agency
State
ZIP Code
E2Name of Employer, Police, Court, or Federal Agency
Do you receive, or have you ever applied for retirement pay, pension, or other pay based on military, Federal civilian, or District of Columbia
Government service?
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; niecB
CBide details below. If you need more space, use a sheet of paper.
Relationship
E,Department, Agency or Branch of Armed Forces
AOYOU 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 100B
If you are a male born after December 31, 1959 you must be registered with the selective Service System or have a valid exemption in
order to be eligible for Federal employment. You will be required to ce
rtify as to your status at the time of appointment.
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 abilityD
and fitness for Federal employment by employers, schools, law enforcement agencies and other individuals and organizations, to investigators, personnel staffing specialists, and other authorized employees of t
he federal Government.
I certify that, to the best of my knowledge and belief, all of my statements are true, correct, complete, and made in good faith.
A-SIGNATURE (Sign each application in dark ink)
DATE SIGNED (Month, day, year)
Page 4
44 - Explain the type, length and amount of the delinquency or default, and steps you are taking to correct errors or repay the debt. Give any
identification number associated witB:h the debt and the address of the Federal agency involved.
Ap39 through 43 - Explain each violation. Give place of occurrence and name/address of police or court involved.
AnBACKGROUND INFORMATION-- You must answer each question in this section before we can process your application.
APNOTE: If you need more space, use a sheet of paper, and include the item number.
State
ZIP Code
E4SIGNATURE, CERTIFICATION, AND RELEASE OF INFORMATION
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Page 2B
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 employB;er before we can offer you a job, we will contact you first
A:READ WORK EXPERIENCE IN THE INSTRUCTIONS BEFORE YOU BEGIN.
Describe your current or most recent job in Block A and work backwards describing each job you held during the past 10 years. If you were unemployed for longer than 3 months within the past 10 years, list B8the dates and your address(es) in an experience
block.
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 responsibB'ilities in a separate experience block.
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 separate block.
INCLUDE VOLUNTEER WORK (non-paid work) --If the work (or a part of he work) is like the job you are applying for, complete all parts of the experience block just as you would for a paying job. YouBr may receive credit for work experience with religious, community, welfare, service,and other organizations.
IF YOU NEED MORE SPACE TO DESCRIBE A JOB--Use sheets of paper the same size as this page (be sure to include all information we ask for in A and B below). On each sheet show your name, Social Security Number, a
B(nd the announcement number or job title.
EIIF YOU NEED MORE EXPERIENCE BLOCKS, use the SF 171-A or a sheet of paper.
EdIF YOU NEED TO UPDATE (ADD MORE RECENT JOBS), use the SF 172 or a sheet of paper as described above.
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
E!Number of employees you supervise
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (forBz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
Page 2
AUIF YOU NEED MORE EXPERIENCE BLOCKS, USE SF 171-A (SEE BACK SIDE OF INSTRUCTION PAGE).
E!Average number of hours per week
A_WORK EXPERIENCE If you have no work experience, write "NONE" in A below and go to 25 on page 3.
E"For Agency Use (skill codes, etc.)
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
From:
Salary or earnings
Starting $
+E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (forBz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E"For Agency Use (skill codes, etc.)
E!Number of employees you supervise
E!Average number of hours per week
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Page 3B
Did you graduate from high school? If you have a GED high school equivalency or will graduate within the next nine months, answer
A.If
, give the highest grade you completed.
Write the name and location (city and state) of the last high school you attended or where you obtained your GED high school equivalency.
E2Have you ever attended
college or graduate school?
NAME AND LOCATION (city, state and ZIP code) OF COLLEGE OR UNIVERSITY . If you expect to graduate within nine months, give month and year you expect to receive your degree:
MONTH AND YEAR ATTENDED
E&NUMBER OF CREDIT HOURS COMPLETED
TYPE OF
DEGREE
(e.g.B.A.,M.A)
MONTH AND
YEAR OF
DEGREE
, continue with 28.
State
ZIP Code
Semester
Quarter
A9CHIEF UNDERGRADUATE SUBJECTS
Show major on the first line
E NUMBER OF CREDIT
HOURS COMPLETED
Semester
Quarter
A4CHIEF GRADUATE SUBJECTS
Show major on the first line
If you have completed any other courses or training related to the kind of jobs you are applying for (trade, vocational, Armed Forces, business) give information below.
A7NAME AND LOCATION (city, state and ZIP Code) OF SCHOOL
School Name
School Name
MONTH AND YR
ATTENDED
CLASS-
HOURS
SUBJECT(S)
TRAINING
COMPLETED
Give the title and year of any honors, awards or fellowships you have received. List your special qualifications, skills, or accomplishments that may help you get a job. Some examples are: skills with computerB
s or other machines; most important publications (do not submit copies); public speaking and writing experience; membership in professional or scientific societies; patents or inventions; etc.
A;How many words per
minute can you:
TYPE? TAKE DICTATION?
E0Agencies may test your
skills before hiring you.
List job-related licenses or certificates that you have, such as: registered nurse; lawyer; radio operator; driver's; pilot's; etc.
LICENSE OR CERTIFICATE
E%DATE OF LATEST LICENSE
OR CERTIFICATE
STATE OR OTHER
LICENSING AGENCY
Do you speak or read a language other than English (include sign language)? Applicants for jobs that require a language other than English may be given an interview conducted solely in that language.
AQIf
, list each language and place an
in each column that applies to you.
LANGUAGE(S)
CAN PREPARE AND GIVE LECTURES
Fluently
With Difficulty
CAN SPEAK AND UNDERSTAND
CAN TRANSLATE ARTICLES
CAN READ ARTICLES FOR OWN USE
With Difficulty
Fluently
Passably
Into English
From English
Easily
List three people who are not related to you and are not supervisors you listed under 24 who know your qualifications and fitness for the kind of job for which you are applying. At least one should know you B
well on a personal basis.
FULL NAME OF REFERENCE
A'TELEPHONE NUMBER(S)
(Include Area Code)
A:PRESENT BUSINESS OR HOME ADDRESS
(Number, street and city)
STATE
ZIP CODE
Page 3
E EDUCATION
E*SPECIAL SKILLS, ACCOMPLISHMENTS AND AWARDS
REFERENCES
E NUMBER OF CREDIT
HOURS COMPLETED
Semester
Quarter
State
ZIP Code
State
ZIP Code
ACIf
, give month and year graduated
or received GED equivalency
, go to 36.
, go to 31.
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Page 1B
E)Application for Federal Employment-SF 171
A^Read the instructions before you complete this application. Type or print clearly in dark ink.
GENERAL INFORMATION
AOWhat kind of job are you applying for? Give title and announcement no. (if any)
Social Security Number
Birth date (Month, Day, Year)
Female
A&Birthplace (City and State or Country)
Name (Last, First, Middle)
A2Mailing address (include apartment number, if any)
A9Other names ever used (e.g., maiden name, nickname, etc.)
State
ZIP Code
Home Phone
E Area Code
Number
Work Phone
E Area Code
Number
E Extension
Were you ever employed as a civilian by the Federal Government? If
, go to Item 11. If
, mark each type of job you held with an
E Temporary
Career-Conditional
Career
Excepted
A@What is your highest grade, classification series and job title?
Dates at highest grade: FROM
AVAILABILITY
A)When can you start work?
(Month and Year)
E3In what geographic area(s) are you willing to work?
AoWhat is the lowest pay you will accept? (You will not be considered for jobs which pay less than you indicate.)
Pay $
OR Grade
Page 1
E7THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
E&PREVIOUS EDITION USABLE UNTIL 12-31-90
NSN 7540-00-935-7150
171-110
Standard Form 171 (Rev. 6-88)
E#U.S. Office of Personnel Management
FPM Chapter 295
Are you willing to work:
E'MILITARY SERVICE AND VETERAN PREFERENCE
Have you served in the United States Military Service? If your only active duty was training in the Reserves or National Guard,answer
. If
, go to item 22
ERDid you or will you retire at or above the rank of major or lieutenant commander?
E-Are you willing to travel away from home for:
A!A. 40 hours per week (full-time)?
E". . . . . . . . . . . .
A%B. 25-32 hours per week (part-time) ?
. . . . . . . . .
A$C. 17-24 hours per week (part-time)?
. . . . . . . . . .
A*D. 16 or fewer hours per week (part-time)?
. . . . . . .
A*E. An intermittent job (on-call/seasonal)?
. . . . . . .
PE(F. Weekends, shifts, or rotating shifts?
. . . . . . . . .
E0Are you willing to take a temporary job lasting:
A%A. 5 to 12 months (sometimes longer)?
. . . . . . . .
B. 1 to 4 months?
E:. . . . . . . . . . . . . . . . . . . .
C. Less than 1 month?
E1. . . . . . . . . . . . . . . . .
A. 1 to 5 nights each month?
E(. . . . . . . . . . . . . .
B. 6 to 10 nights each month?
E%. . . . . . . . . . . . .
E C. 11 or more nights each month?
. . . . . . . . . . .
E=. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . .
Form Approved
OMB No. 3206-0012
E FOR USE OF EXAMINING OFFICE ONLY
Form reviewed:
Form Approved:
Date entered register
Option
Grade
Earned
Rating
Veteran
Preference
Augmented
Rating
Preference
Claimed
5 Points
(Tentative)
A 10 Pts. (30%
Or More
Comp. Dis.)
A!10 Pts. (Less
Than 30%
Comp. Dis)
Other
10 Points
Disallowed
Being
Investigated
Initials and Date
E{Preference has been verified through proof that the separation
was under honorable conditions, and other proof as required.
5-Point
E,10-Point--30% or More
Compensable Disability
E.10-Point--Less than 30% Compensable Disability
10-Point--Other
Signature and Title
Agency
Were you discharged from the military service under honorable
conditions? (If your discharge was changed to
honorable
general
by a Discharge Review Board, answer
. If you
received a clemency dischBXarge, answer
.) If
, provide below the date and type of discharge you received.
A!Discharge Date
(Month, Day, Year)
Type of Discharge
ASList the dates (Month, Day, Year), and branch for all active duty military service.
Branch of Service
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.
Read the instructions that came with this form before completing this item. When you have determined your eligibility for veteran preference from the instructions, place an
in the box next to your veteran pB
reference claim.
NO PREFERENCE
E>5-POINT PREFERENCE - - You must show proof when you are hired.
10-POINT PREFERENCE - - If you claim 10-point preference, place an
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 fo
r 10-Point Veteran Preference, which is available from any Federal Job Information Center. ATTACH THE COMPLETED SF 15 AND REQUESTED PROOF TO THIS APPLICATION.
E3Non-compensably disabled or Purple Heart recipient.
E+Compensably disabled, less than 30 percent.
E?Spouse, widow(er), or mother of a deceased or disabled veteran.
E)Compensably disabled, 30 percent or more.
E/MILITARY SERVICE AND VETERAN PREFERENCE (Cont.)
DO NOT WRITE IN THIS AREA
E!FOR USE OF APPOINTING OFFICE ONLY
E Cherokee Software (206) 919-7588
171 Mac Ver 6.2
PG 2 E-F
PG 2 G-H
Print Application
PG 2 I-J
PG 2 K-L
PG 2 M-N
PG 2 O-P
PG 2 C-D
Page 2C-D Additional ExperienceB
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
E!Number of employees you supervise
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (forBz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E!Average number of hours per week
E"For Agency Use (skill codes, etc.)
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (forBz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E"For Agency Use (skill codes, etc.)
E!Number of employees you supervise
E!Average number of hours per week
A3Standard Form 171-A - Continuation Sheet for SF 171
Attach all SF 171- A's to your application at the top of page 3.
A%1. Name (Last, First, Middle Initial)
E23. Job Title or Announcement You Are Applying For.
2. Social Security Number
4. Date Completed
AOTHE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
PREVIOUS EDITION USABLE
IEQStandard Form 171 (Rev. 6-88)
U.S. Office of Personnel Management
FPM Chapter 295
E!ADDITIONAL WORK EXPERIENCE BLOCKS
PG 2 E-F
PG 2 G-H
Print Application
PG 2 I-J
PG 2 K-L
PG 2 M-N
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PG 2 C-D
Page 2E-F Additional ExperienceB
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
E!Number of employees you supervise
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (for
Bz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E!Average number of hours per week
E"For Agency Use (skill codes, etc.)
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (forBz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E"For Agency Use (skill codes, etc.)
E!Number of employees you supervise
E!Average number of hours per week
A3Standard Form 171-A - Continuation Sheet for SF 171
Attach all SF 171- A's to your application at the top of page 3.
A%1. Name (Last, First, Middle Initial)
]E23. Job Title or Announcement You Are Applying For.
2. Social Security Number
4. Date Completed
AOTHE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
PREVIOUS EDITION USABLE
EQStandard Form 171 (Rev. 6-88)
U.S. Office of Personnel Management
FPM Chapter 295
E!ADDITIONAL WORK EXPERIENCE BLOCKS
PG 2 C-D
PG 2 E-F
PG 2 G-H
Print Application
PG 2 I-J
PG 2 K-L
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PG 2 O-P
Page 2G-H Additional ExperienceB
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
E!Number of employees you supervise
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (forBz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E!Average number of hours per week
E"For Agency Use (skill codes, etc.)
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (for
Bz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E"For Agency Use (skill codes, etc.)
E!Number of employees you supervise
E!Average number of hours per week
A3Standard Form 171-A - Continuation Sheet for SF 171
Attach all SF 171- A's to your application at the top of page 3.
A%1. Name (Last, First, Middle Initial)
E23. Job Title or Announcement You Are Applying For.
2. Social Security Number
4. Date Completed
AOTHE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
PREVIOUS EDITION USABLE
EQStandard Form 171 (Rev. 6-88)
U.S. Office of Personnel Management
FPM Chapter 295
E!ADDITIONAL WORK EXPERIENCE BLOCKS
PG 2 E-F
PG 2 G-H
Print Application
PG 2 I-J
PG 2 K-L
PG 2 M-N
PG 2 O-P
PG 2 C-D
Page 2I-J Additional ExperienceB
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
E!Number of employees you supervise
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (forBz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E!Average number of hours per week
E"For Agency Use (skill codes, etc.)
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (for
Bz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E"For Agency Use (skill codes, etc.)
E!Number of employees you supervise
E!Average number of hours per week
A3Standard Form 171-A - Continuation Sheet for SF 171
Attach all SF 171- A's to your application at the top of page 3.
A%1. Name (Last, First, Middle Initial)
E23. Job Title or Announcement You Are Applying For.
2. Social Security Number
4. Date Completed
AOTHE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
PREVIOUS EDITION USABLE
EQStandard Form 171 (Rev. 6-88)
U.S. Office of Personnel Management
FPM Chapter 295
E!ADDITIONAL WORK EXPERIENCE BLOCKS
PG 2 E-F
PG 2 G-H
Print Application
PG 2 I-J
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PG 2 C-D
Page 2K-L Additional ExperienceB
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
E!Number of employees you supervise
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (forBz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E!Average number of hours per week
E"For Agency Use (skill codes, etc.)
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (for
Bz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E"For Agency Use (skill codes, etc.)
E!Number of employees you supervise
E!Average number of hours per week
A3Standard Form 171-A - Continuation Sheet for SF 171
Attach all SF 171- A's to your application at the top of page 3.
A%1. Name (Last, First, Middle Initial)
E23. Job Title or Announcement You Are Applying For.
2. Social Security Number
4. Date Completed
AOTHE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
PREVIOUS EDITION USABLE
EQStandard Form 171 (Rev. 6-88)
U.S. Office of Personnel Management
FPM Chapter 295
E!ADDITIONAL WORK EXPERIENCE BLOCKS
PG 2 E-F
PG 2 G-H
Print Application
PG 2 I-J
PG 2 K-L
PG 2 M-N
PG 2 O-P
PG 2 C-D
Page 2M-N Additional ExperienceB
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
E!Number of employees you supervise
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (forBz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E!Average number of hours per week
E"For Agency Use (skill codes, etc.)
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (for
Bz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E"For Agency Use (skill codes, etc.)
E!Number of employees you supervise
E!Average number of hours per week
A3Standard Form 171-A - Continuation Sheet for SF 171
Attach all SF 171- A's to your application at the top of page 3.
A%1. Name (Last, First, Middle Initial)
E23. Job Title or Announcement You Are Applying For.
2. Social Security Number
4. Date Completed
AOTHE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
PREVIOUS EDITION USABLE
EQStandard Form 171 (Rev. 6-88)
U.S. Office of Personnel Management
FPM Chapter 295
E!ADDITIONAL WORK EXPERIENCE BLOCKS
PG 2 E-F
PG 2 G-H
Print Application
PG 2 I-J
PG 2 K-L
PG 2 M-N
PG 2 O-P
PG 2 C-D
Page 2O-P Additional ExperienceB
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
E!Number of employees you supervise
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (forBz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E!Average number of hours per week
E"For Agency Use (skill codes, etc.)
AHName and address of employer's organization (include ZIP Code, if known)
A)Dates employed (give month, day and year)
From:
Salary or earnings
Starting $
E Ending $
E Your reason for wanting to leave
Your immediate supervisor
E Area Code
Telephone No.
Exact title of your job
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, 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 supervise. If you describe more than one type of work (for
Bz example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
E"For Agency Use (skill codes, etc.)
E!Number of employees you supervise
E!Average number of hours per week
A3Standard Form 171-A - Continuation Sheet for SF 171
Attach all SF 171- A's to your application at the top of page 3.
A%1. Name (Last, First, Middle Initial)
E23. Job Title or Announcement You Are Applying For.
2. Social Security Number
4. Date Completed
AOTHE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
PREVIOUS EDITION USABLE
EQStandard Form 171 (Rev. 6-88)
U.S. Office of Personnel Management
FPM Chapter 295
E!ADDITIONAL WORK EXPERIENCE BLOCKS
PG 2 E-F
PG 2 G-H
Print Application
PG 2 I-J
PG 2 K-L
PG 2 M-N
PG 2 O-P
PG 2 C-D
Job ReportB
SF-171 Jobs Applied For
Applicant Name
Position
Date Signed
PG 2 E-F
PG 2 G-H
Print Report
PG 2 I-J
PG 2 K-L
PG 2 M-N
PG 2 O-P
PG 2 C-D
A Main MenuB
E Main Menu
SF-171 Job Application Template
SF-171 Job Application Template
SF-171 Job Application Template
Register
Version 6.2
SF-171 Template
Report
About Cherokee
EGCherokee Software
18011 SE 266th Pl
Kent, WA 98042
(206) 919-7588
Tips & Info
Order FormB
E SUB-TOTAL
E TOTAL DUE
SF-171 Job Application Template
Order Form
EACherokee Software
18011 SE 266th Pl
Kent, WA 98042
(206) 919-7588
E Your Name
Address
State
Daytime Phone
Evening Phone
Complete this form and mail to:
Version 6.2
E SALES TAX
Make Checks Payable To:
Cherokee Software
UNIT PRICE
DESCRIPTION
TOTALS
Suggestions
E$Thank You For Supporting ShareWare!!
Order Form
Rev 9/1/94
PG 2 E-F
PG 2 G-H
Print Order Form
PG 2 I-J
PG 2 K-L
PG 2 M-N
PG 2 O-P
PG 2 C-D
E;Commercial On-Line Address
(Compuserve, AOL, Genie, etc...)
Internet Address
SF-171 InfoB
If you
d like to purchase the password that unlocks this template, simply select the register button below, fill out, print, and mail the order form along with $10.00 to:
Cherokee Software
18011 SE 2
66th Pl
Kent, WA 98042
You will be contacted either by phone, Email if possible, or by regular mail with the password within 24 hours after receipt of the shareware fee. Please see the ReadMe SF-171 fileC
for more information.
We wish to thank all the users who have sent in their shareware fee. Without your support and suggestions this wouldn
t have been possible.
ExFileMaker is
1988-1994 by Claris Corporation and is a registered trademark of Claris Corporation. All Rights Reserved.
Register
AGAmerica On-Line Address: The Bill
Internet Address: thebill@aol.com
Tips & Info
Tips & InfoB
PG 2 E-F
PG 2 G-H
PG 2 E-F
PG 2 G-H
Print Report
PG 2 I-J
PG 2 K-L
PG 2 M-N
PG 2 O-P
PG 2 C-D
Tips & Info
This template was created to make applying for federal jobs easier. I had the opportunity to fill out the SF-171 with a typewriter a few years ago. There had to be an easier way. I searched all the usual source
us a call. And finally if you want us to whip up a custom version of your ideas give us a call, the worst thing we could say is no....
We wish you luck in your search and thank you for considering our productY s.
Sincerely
Cherokee Software
ar. Each button has a corresponding command in the script menu.
Versions:
We at Cherokee Software are always trying to come up with better ideas and ways of doing things. This software has gone through many rW
evisions in the past year. If you feel you want the newest version or would like a Windows version give us a call. If there is anything you would like to be able to do with this template that it doesn't do give
outs and remove the word DEMO from all the layouts. Simply highlight each one and press the delete key. I would recommend that you make a backup of the original program before you do this. FileMaker can sometimU
es be very unforgiving.
The Button Bar:
The bar of buttons across the top of each page allows you to quickly navigate around the form to the various pages. You can even print the entire form from the button b
his template will not be held responsible for its use. Check with the federal agency you are applying with to see if they will accept a computer generated copy of the SF-171 before you apply. We will not be resS
ponsible if your application is not accepted and you miss an opportunity with the Federal Government. The user of this template accepts full responsibility of its use.
After You Receive The Password:
Goto lay
een is small and sometimes hard to read. We recommend that you print a blank form to follow along as you fill it out or zoom the form to 200% size while filling it out. We wanted to match every aspect of the GoQ
vernments SF-171 form so a decision was made to use the small font sizes they used
Legal Stuff:
This template is not endorsed by Apple Computer
or the Federal Government. Cherokee software or the author of t
driver doesn
t have this option you can reduce the print size to about 96% and that should do the trick, you may have to experiment with the reduction size.
The template has been tested with various Apple
inter configurations and prints to any of the Apple
printers including the ImageWriters, StyleWriters, and Laser printers. We can
t be certain about other brands, makes and models.
I know the font size on scr
reported while using ATM. Our recommendation is to turn off ATM when using this template, but make sure you have installed the true type fonts first.
Make sure you select
Larger Print Area (Fewer DownloadableM
Fonts)
from the Options button from within the Page Setup dialog box. In order for us to get all the information that is packed onto each page, we had to use every square inch of available page. If your print
Software/Hardware Required:
Any Macintosh capable of running FileMaker Pro 2.0 or above, either b/w or color (color is preferred).
FileMaker Pro 2.0 or above for Macintosh or Windows.
Known Problems:
recommend that you use Helvetica, Geneva and Times Truetype fonts available from Apple Computer or included with System 7.X. This will give you the proper screen layouts. Some screen layout problems have been
ess: The Bill
Internet Address: thebill@aol.com
We promise to send you the password either on-line, in the mail, or by phone within 24 hours of receipt of the ShareWare fee of $10.00. For the fastest respI
onse please include your Commercial on-line address, (Compuserve, AOL, GENIE, Internet address etc...), with your order. The password will allow full access to the template,where you can modify any aspect of it
eceive the password. The ShareWare fee is $10.00. To receive the password that unlocks this template allowing you to remove the DEMO notice, simply select the Register button from the splash screen, main menu oG
r Scripts menu, fill out, print and mail the order form along with $10.00 to Cherokee Software.
Cherokee Software
18011 SE 266th Pl
Kent, WA 98042
(206) 919-7588
You can reach me at:
America On-Line Addr
sion before including this template on any CD-ROM, or ShareWare disk. Cherokee Software reserves all rights to this template.
The SF-171 Application Template is password protected. You will be able to enter inE
formation, edit, and print, but each page will have the word DEMO printed across it. You can edit the existing record and play around with the form, but you won't be able to create any new records until you r
s and found some solutions for the DOS world by nothing for the Macintosh or Windows. Alas SF-171 Application Template for FileMaker Pro
was born.
This template is distributed as ShareWare. You can freely disC
tribute the template so long as the SF-171 Readme file is included (unmodified) and the SF-171 Application template is the original unmodified version with password intact. Please contact us and ask our permis
(.txt)