ࡱ> @ 2bjbjFF C,,:.......$R4444B5Re6 l@l@l@l@A]GIDccccccc$RfRhc}.JPA"AJPJPc..l@l@9VeTTTJP".l@.l@cTJPcTT2[..]l@6 pmk4lP\./]le0e\.HiP"Hi\]RR....Hi.] %K5LTLM%K%K%KccRRD34T RR4Form Approved OMB No. 3206-0219 OPTIONAL APPLICATION FOR FEDERAL EMPLOYMENT - OF 612 You may apply for most jobs with a resume, this form, or other written format. If your resume or application does not provide all the information requested on this form and in the job vacancy announcement you may lose consideration for a job. 1 Job title in announcement  FORMTEXT      2 Grade(s) applying for  FORMTEXT       3 Announcement Number  FORMTEXT       4 Last Name  FORMTEXT      First and middle names  FORMTEXT       5 Social Security Number  FORMTEXT       Mailing Address  FORMTEXT       7 Phone numbers (include area code) Daytime  FORMTEXT       City  FORMTEXT      State Zip Code  FORMTEXT        FORMTEXT        Evenings  FORMTEXT       Work Experience Describe your paid and non-paid experience related to the job for which you are applying. Do not attach job descriptions.  1) Job title (If federal, include series and grade)  FORMTEXT        From (MM/YYYY)  FORMTEXT      To (MM/YYYY)  FORMTEXT      Salary Per $  FORMTEXT        FORMTEXT       Hours per week  FORMTEXT       Employer's name and address  FORMTEXT      Supervisor's name and phone number  FORMTEXT        FORMTEXT       Describe your duties and accomplishments  FORMTEXT        2) Job title (If federal, include series and grade)  FORMTEXT        From (MM/YYYY)  FORMTEXT      To (MM/YYYY)  FORMTEXT      Salary Per $  FORMTEXT        FORMTEXT       Hours per week  FORMTEXT       Employer's name and address  FORMTEXT      Supervisor's name and phone number  FORMTEXT        FORMTEXT        Describe your duties and accomplishments  FORMTEXT       May we contact your current supervisor? 9 Yes  FORMCHECKBOX No  FORMCHECKBOX  > If we need to contact your current supervisor before making you an offer, we will contact you first.50612-101 NSN 7540-01-351-9178 Optional Form 612 (September 1994) U.S. Office of Personnel Management OPTIONAL APPLICATION FOR FEDERAL EMPLOYMENT- OF 612 - Employer Continuation Page 2 1 Job title in announcement  FORMTEXT      2 Grade(s) applying for  FORMTEXT       3 Announcement Number  FORMTEXT       4 Last Name  FORMTEXT      First and middle names  FORMTEXT       5 Social Security Number  FORMTEXT       Mailing Address  FORMTEXT       City  FORMTEXT      State Zip Code  FORMTEXT        FORMTEXT       Work Experience Describe your paid and non-paid experience related to the job for which you are applying. Do not attach job descriptions.  3) Job title (If federal, include series and grade)  FORMTEXT        From (MM/YYYY)  FORMTEXT      To (MM/YYYY)  FORMTEXT      Salary Per $  FORMTEXT        FORMTEXT       Hours per week  FORMTEXT       Employer's name and address  FORMTEXT      Supervisor's name and phone number  FORMTEXT        FORMTEXT       Describe your duties and accomplishments  FORMTEXT        4) Job title (If federal, include series and grade)  FORMTEXT        From (MM/YYYY)  FORMTEXT      To (MM/YYYY)  FORMTEXT      Salary Per $  FORMTEXT        FORMTEXT       Hours per week  FORMTEXT       Employer's name and address  FORMTEXT      Supervisor's name and phone number  FORMTEXT        FORMTEXT        Describe your duties and accomplishments  FORMTEXT       50612-101 NSN 7540-01-351-9178 Optional Form 612 (September 1994) U.S. Office of Personnel Management OPTIONAL APPLICATION FOR FEDERAL EMPLOYMENT- OF 612 - Employer Continuation Page 3 1 Job title in announcement  FORMTEXT      2 Grade(s) applying for  FORMTEXT       3 Announcement Number  FORMTEXT       4 Last Name  FORMTEXT      First and middle names  FORMTEXT       5 Social Security Number  FORMTEXT       Mailing Address  FORMTEXT       City  FORMTEXT      State Zip Code  FORMTEXT        FORMTEXT       Work Experience Describe your paid and non-paid experience related to the job for which you are applying. Do not attach job descriptions.  1) Job title (If federal, include series and grade)  FORMTEXT        From (MM/YYYY)  FORMTEXT      To (MM/YYYY)  FORMTEXT      Salary Per $  FORMTEXT        FORMTEXT       Hours per week  FORMTEXT       Employer's name and address  FORMTEXT      Supervisor's name and phone number  FORMTEXT        FORMTEXT       Describe your duties and accomplishments  FORMTEXT        2) Job title (If federal, include series and grade)  FORMTEXT        From (MM/YYYY)  FORMTEXT      To (MM/YYYY)  FORMTEXT      Salary Per $  FORMTEXT        FORMTEXT       Hours per week  FORMTEXT       Employer's name and address  FORMTEXT      Supervisor's name and phone number  FORMTEXT        FORMTEXT        Describe your duties and accomplishments  FORMTEXT       50612-101 NSN 7540-01-351-9178 Optional Form 612 (September 1994) U.S. Office of Personnel Management OPTIONAL APPLICATION FOR FEDERAL EMPLOYMENT- OF 612 - Education Continuation Page 4 10 Mark highest level completed Some HS  FORMCHECKBOX  HS/GED  FORMCHECKBOX  Associate  FORMCHECKBOX  Bachelor  FORMCHECKBOX  Master  FORMCHECKBOX  Doctoral  FORMCHECKBOX  11 Last high school (HS) or GED school's name, city, State, Zip Code (If known), and year diploma or GED received  FORMTEXT      12 College and universities attended. Do not attach a copy of your transcript unless requested.1) NameTotal Credits EarnedMajor(s)Degree - Year FORMTEXT       SemesterQuarter(if any)CityStateZip Code FORMTEXT        FORMTEXT    FORMTEXT        FORMTEXT        FORMTEXT       FORMTEXT        FORMTEXT      2)  FORMTEXT       FORMTEXT        FORMTEXT    FORMTEXT        FORMTEXT        FORMTEXT       FORMTEXT        FORMTEXT      3)  FORMTEXT       FORMTEXT        FORMTEXT    FORMTEXT        FORMTEXT        FORMTEXT       FORMTEXT        FORMTEXT      OTHER QUALIFICATIONS Job-related training courses (give title and year). Job-related skills (other languages, computer software/hardware, tools, machinery, typing speed, etc.). Job related certificates and licenses (current only.) Job-related honors, awards and special accomplishments (publications, memberships in professional/honor societies, leadership activities, public speaking, and performance awards). Give dates, but do not send documents unless requested.  FORMTEXT      GENERAL 14 Are you a U.S. citizen? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Give the country of your citizenship  FORMTEXT       15 Do you claim veteran's preference? No  FORMCHECKBOX  Yes  FORMCHECKBOX  Mark your claim of 5 or 10 points below 5 points FORMCHECKBOX  Attach your DD-214 or 10 points  FORMCHECKBOX  Attach an Application for 10 point Veterans Preference (SF-15) and other proof proof required. 16 Were you ever a Federal Civilian employee? No  FORMCHECKBOX  Yes  FORMCHECKBOX  For highest civilian grade give:  UI K i j t u   F H \ ^ ` j l p x    P R f h j t v | ~   jhRUjhRUjEhRUjhRUjhRUjh4XUmHnHujhRUjhRU hR5hR hR5CJ hRCJ9 UH I e  > n p $If$a$ 2  J x | ysssssss$Ifkdf$$IfTl F ' d :0    4 laT  0 2 yoiiiii$If & F$Ifkdm$$IfTl F '@  :0    4 laT " , . 2 6      ( * ^ ` t v x : "ڿڴکڞړj hRUj hRUj hRUjM hRUjhRUjhRU hR5hRjh4XUmHnHujhRUjLhRU7  , ^ $Ifrkd$$IfTl00':04 laT<24ysis & F$If$IfkdI $$IfTlF ' d :0    4 laT4649_kd $$IfTl'")04 laT$If_kd( $$IfTl '")04 laT"$&02RThjlvx8:NPR\^$&:<>HJfh|~ڹڮڣژڍjhRUjhRUj7hRUjhRUjhRUj>hRUj6hRUhRjh4XUmHnHujhRUj*hRU74Nz8`b$bkdF$$IfTl\:' 04 laT$If $L&(rkdo$$IfTl@0'04 laT$If"$024>@`bvxz "FH\^`jl&(jhRUjhRUj$hRUjhRUj8hRUjhRUjhRUjh4XUmHnHujhRUj8hRUhR8(* 9_kd+$$IfTl '")04 laT$If_kd$$IfTl '")04 laT B\&(Fnp`kd$$IfTl\:' 04 laT$If &NPxz|  rkdY$$IfTl,0'04 laT$If(<>@JLPRfhjtvjlikl  FH\^`jjy#hRUj"hRU hR5 hRCJ hR5CJ hRCJj[ hRUjEhRUj"hRUjhRUjh4XUmHnHujhRUjmhRUhR2 ^BC/_kd_!$$IfTl'")04 laT$If %$If_kd$$IfTlp'")04 laTjk>np$If %_kd"$$IfTl'")04 laT %$If jlpx  PRfhjtv|~  ",.@BVXZdfj$+hRUj*hRUj(hRUjR'hRUj&hRUj%hRUjh4XUmHnHujA$hRU hR5hRjhRU:Jx|ysssssss$Ifkd %$$IfTlF ' d :0    4 laT024yoiii$If & F$Ifkd ($$IfTlF '@  :0    4 laT46@h$Ifrkd)$$IfTl00':04 laT 68LNPZ\  2 4 6 @ B j2hRUj1hRUjI1hRUjA0hRUj5/hRUj-hRU hR5jh4XUmHnHujhRUj+hRUhR6 ysis & F$If$IfkdT,$$IfTlF ' d :0    4 laT9_kd.$$IfTl'")04 laT$If_kd3-$$IfTl '")04 laT2^ D F bkdQ3$$IfTl\:' 04 laT$If !!!! !>!@!T!V!X!b!d!!!!!!!!"""""""""# # ###8#:#N#P#R#\#^##########ڹڮڣژڍj:hRUjC:hRUj9hRUj8hRUjC7hRUj5hRUj 5hRUhRjh4XUmHnHujhRUjB4hRU7 &!f!h!!!"rkdz6$$IfTl@0'04 laT$If""v"""""9_kd69$$IfTl '")04 laT$If_kd)8$$IfTl '")04 laT"#4#`###$$F$H$$$`kd<$$IfTl\:' 04 laT$If ######$ $4$6$8$B$D$$$$$$$$$%%%%"%$%(%*%>%@%B%L%N%%%%%%%%'''r's'u'''''( ( (jvAhRU hR5 hR5CJ hRCJj-?hRUj=hRUjx=hRUj=hRUj;hRUjh4XUmHnHujhRUj/;hRUhR5$$&%(%P%R%T%%%rkdd>$$IfTl,0'04 laT$If%%%%z&'9/ %$If_kd:@$$IfTl'")04 laT$If_kd?$$IfTlp'")04 laT'''r's''(>(n(p(((($If %_kd@$$IfTl'")04 laT (((F(H(\(^(`(j(l(p(x(((((((((((( ) ))))P)R)f)h)j)t)v)|)~))))))))* ** *"*,*.*@*B*V*X*Z*d*f**jiIhRUjGhRUj-FhRUjmEhRUjDhRUjChRUjh4XUmHnHujTBhRUjhRU hR5hR:((()J)x)|)))ysssssss$IfkdC$$IfTlF ' d :0    4 laT))*0*2*4*yoiii$If & F$IfkdF$$IfTlF '@  :0    4 laT4*6*@*h*****$IfrkdH$$IfTl00':04 laT**************++++,,,,,,,,,-- ---6-8-L-N-P-Z-\---------------..2.jPhRUj$PhRUjOhRUjNhRUjLhRU hR5jJhRUjh4XUmHnHujIhRUhRjhRU7*+ +,,ysis & F$If$Ifkd/K$$IfTlF ' d :0    4 laT,,,,,,-9_kdkM$$IfTl'")04 laT$If_kdL$$IfTl '")04 laT-2-^----.D.F....bkd,R$$IfTl\:' 04 laT$If 2.4.6.@.B..........//// />/@/T/V/X/b/d////////0000000001 1 11181:1N1P1R1\1^111ڹڮڣژڍjYhRUjXhRUjWhRUjVhRUjThRUjShRUjShRUhRjh4XUmHnHujhRUjfQhRU7."/f/h///0rkdUU$$IfTl@0'04 laT$If00v000009_kdX$$IfTl '")04 laT$If_kdW$$IfTl '")04 laT0141`11122F2H222`kdZ$$IfTl\:' 04 laT$If 11111111111112 2426282B2D2222222233333$3&3*3,3@3B3D3N3P3333333355 5V5_5t5 hR5 hR5CJ hRCJj^hRUj\hRUjS\hRUj[hRUjZhRUj ZhRUjh4XUmHnHujhRUjYhRUhR523(3*3R3T3V333rkd?]$$IfTl,0'04 laT$If3333{459/ %$If_kd-_$$IfTl'")04 laT$If_kd^$$IfTlp'")04 laT555u5v56~77 %$If %_kd_$$IfTl'")04 laTt5u5v555555555555555566 6"6$6:6<6X6Z6\6v6x66666~77777777f8j888888899jihRUjh4XUmHnHuj%fhRUj=ehRUjWdhRUjcchRUjibhRUjmahRUji`hRUjhRUhR hRCJ hR5377h8j887]kdg$$IfTl'&(04 laT %$If_kdIg$$IfTl@'&(04 laT8888899(9*9<9[QQQQ %$Ifkd[h$$IfTl\2 V' $ N 04 laT $ %$Ifa$ 99(9*9<9>9p9r99999999999999999999999:: ::::(:*:,:6:8:::<:P:R:T:^:`:d:f:z:jphRCJUjohRCJUjohRCJUjonhRCJUjmhRCJUjh4XCJUmHnHujlhRCJUjhRCJU hRCJhR2<9>9H9T9f9h9j9l9n9SIIIIIII %$IfkdIj$$IfTlr2 xV' FN 04 laTn9p9999/%%% %$Ifkdk$$IfTl֞2 xV'FN 04 laT999::::b:: %$Ifz:|:~::::::::::::::::::::;; ;;;;;(;*;,;6;8;<;>;R;T;V;`;b;f;h;|;λƭҠғ҆yjvhRCJUjuhRCJUjIuhRCJUjthRCJUjh4XUmHnHuj1shRUjhRUhR hRCJjh4XCJUmHnHujhRCJUjOqhRCJU+::::-## %$Ifkdq$$IfTl֞2 xV'FN 04 laT:::::;:;d;f;;;; %$Ifrkds$$IfTl02 ' 04 laT |;~;;;;;;;;;;;;;;;;;;;;;<<<<<<<.<0<2<<<><D<F<Z<\<^<b<d<f<h<|<ҸҴ҆yj|hRCJUj{hRCJUjh4XUmHnHujzhRUjhRUhRjxhRCJUj!xhRCJU hRCJjh4XCJUmHnHujhRCJUjawhRCJU+;;<<-## %$IfkdQy$$IfTl֞2 xV'FN 04 laT<<@<B<D<f<<<<< =4= %$Ifrkd?{$$IfTl02 ' 04 laT |<~<<<<<<<<<<<<<<<<<<<<<<<== =="=$=&=0=2=6=`=s?t?u???@ @ @@ @ҸҫҞҗғrjh4XUmHnHujՁhRUjhRUhR hR5CJjhRCJUjshRCJUj~hRCJUj}hRCJU hRCJjh4XCJUmHnHujhRCJUjQ}hRCJU,4=6=`=s?-' & F % %kd$$IfTl֞2 xV'FN 04 laTs?t?@@ @"@bAdA8B9BBcCdCC  %dkd]$$IfTl(")04 laT %$If @"@&@@@@@@@@@@@:A "$&0246JLNXZ^}jhRCJUjhRCJUjhRCJUjh4XCJUmHnHujhRCJUUjًh4XhRCJUjh4XhRCJUjhRCJU hR5CJ hRCJ h4XCJ1 Series Grade From(MM/YYYY) To(MM/YYYY)  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      17 Are you eligible for reinstatement based on career-conditional status? No  FORMCHECKBOX  Yes  FORMCHECKBOX  If requested, attach SF 50 proof 18 APPLICATION CERTIFICATION I certify that , to the best of my knowledge and belief, all of the information on and attached to this application is true, correct, complete and made in good faith. I understand that false or fraudulent information on or attached to this application may be grounds for not hiring me or for firing me after I begin work, and my be punishable by fine or imprisonment. I understand that any information I give may be investigated.  SIGNATURE DATE SIGNED U.S. GPO: 1994-383-912/09047 GENERAL INFORMATION You may apply for most Federal jobs with a resume, the attached Optional Application for Federal Employment or other written format. If your resume or application does not provide all the information requested on this form and the job vacancy announcement, you may lose consideration for a job. Type or print clearly in dark ink. Help speed the selection process by keeping your application brief and sending only requested information. If essential to attach additional pages, include your name and Social Security Number on each page. For information on Federal employment, including job lists, alternative formats for persons with disabilities, and veteran's preference, call the U.S. Office of Personnel Management at 912-757-3000, TDD 912-744-2299, by computer modem 912-757-3100, or via the Internet (Telnet only) at FJOB.MAIL.OPM.GOV. If you served on active duty in the United States Military and were separated under honorable conditions, you may be eligible for veterans' preference. To receive preference if your service began after October 15, 1976, you must have a Campaign Badge, Expeditionary Medal, or a service connected disability. Veterans' preference is not a factor for Senior Executive Service jobs when competitions limited to status candidates (current or former career or career conditional Federal employees). Most Federal jobs require United States citizenship and males over 18 born after December 31, 1959, have registered with the Selective Service system or have an exemption. The law prohibits public officials from appointing, promoting, or recommending their relatives. Federal annuitants (military and civilian) may have their salaries or annuities reduced. All employees must pay any valid delinquent debts or the agency may garnish their salary. Send your application to the office announcing the vacancy. If you have questions, contact that office. PRIVACY ACT AND PUBLIC BURDEN STATEMENTS The Office of Personnel Management and other Federal agencies rate applications for Federal jobs under the authority of sections 1104,1302, 3301, 3304, 3320, 3361, 3393, and 3394 of title 5 of the United States Code. We need the information requested in this form and in the associated vacancy announcements to evaluate your qualifications. Other laws require us to ask about citizenship, military service, etc. We request your Social Security Number (SSN) under the authority of Executive Order 9397 in order to keep your records straight; other people may have the same name. As allowed by law or Presidential directive, we use your SSN to seek information about you from employers, schools, banks, and others who know you. We may give information from your records to: training facilities; organizations deciding claims for retirement, insurance, unemployment or health benefits; officials in litigation or administrative proceedings where the Government is a party; law enforcement agencies concerning violations or law or regulation; Federal agencies for statistical reports and studies; officials of labor organizations recognized by law in connections with hiring or retaining, security clearances, security or suitability investigations, classifying jobs, contracting, or issuing licenses, grants, or other benefits; public and private organizations including news media that grant or publicize employee recognition and awards; and the Merit Systems protection Board, the Office of Special Counsel, the Equal Employment Opportunity Commission, the Federal Acquisition Institute, and congressional offices in connection with their official functions. We may also give information from your records to: prospective nonfederal employers concerning tenure of employment, civil service status, length of service, and date and nature of action for separation as shown on personnel action forms of specifically identified individuals; requesting organizations or individual concerning the home address and other relevent information on those who might have contracted an illness or been exposed to an health hazard; authorized Federal and nonfederal agencies for use in computer matching; spouses or dependent children asking weather the employee has changed form self and family to self only health benefits enrollment; individuals working on a contract, service, grant, cooperative agreement or job for the Federal Government; non agency members of an agency's performance or other panel; and agency-appointed representatives of employees concerning information issued to the employee about fitness-for-duty or agency filed disability retirement procedures. We estimate the public reporting burden for this collection will vary from 10 to 240 minutes with an average of 40 minutes per response, including time for reviewing instructions, searching existing data sources, gathering data, and completing and reviewing the information. You may send comment regarding the burden estimate or any other aspect of the collection of information, including suggestions for reducing this burden, to U.S. Office of Personnel Management, Reports and Forms Management officer, Washington, DC 20414-0001. 4\^> `ZZZZZZ %kd$$Ifl\N %hB#04 la %$If ^b8:<bdfh `tvx.02h4XhRjh4XhRCJUjlh4XhRCJUjhRCJU h4XCJ hRCJ hR5CJ nprtvzn|~^`z| & F % % %^RT"$.02 & F % %/ =!"#$%# 0/ =!"#$% PDJobTitle Title case&Type the job title on the announcementD GradeApply#Type the grade you are applying forD AnnounceNum$Please enter the announcement number$$If!vh5 5d 5:#v #vd #v::V l 05 5d 5:/ / / 4aTDLastNameEnter your last nameD FirstName Enter your first and middle nameD SSAN ###-##-####!Enter your Social Security Number$$If!vh5@ 5 5:#v@ #v #v::V l 05@ 5 5:/ / / 4aTD MailAddressEnter your mailing addressDText117Enter your daytime telephone number (include area code)$$If!vh55:#v#v::V l0055:/  / / / 4aTDCityEnter your city.DStateEnter your stateDZipEnter your zipcode FillInHeaderDText10#enter your evening telephone number$$If!vh5 5d 5:#v #vd #v::V l05 5d 5:/ / / 4aT$$If!vh5")#v"):V l 05")/  / 4aTDText12!Enter your most recent job title.$$If!vh5")#v"):V l05")/  / 4aT DText13MM/YYYYDEnter your start date at this position, month and year ex. (11/1997)DText14MM/YYYYBEnter your end date at this position, month and year ex. (11/1997)DText15Enter your pay rate.DText16Enter frequency of pay.DText17(Enter the number of hours worked weekly.$$If!vh5 555#v #v#v#v:V l05 555/ /  / 4aTD EmployerInfo.Enter employer's name and employer's address.DText18Enter supervisors name.DText58 Enter supervisor's phone number.$$If!vh55#v#v:V l@055/  / / 4aTDText228Enter a description of your duties and responsibilities.$$If!vh5")#v"):V l 05")/  4aTvDText12$$If!vh5")#v"):V l 05")/  4aTvDText13vDText14vDText15vDText16vDText17$$If!vh5 555#v #v#v#v:V l05 555/ / 4aTvDText23vDText18vDText19$$If!vh55#v#v:V l,055/  / / 4aTDDescriob TabSlowly$$If!vh5")#v"):V lp05")/  4aTDe YesContact>Check if you would like to allow us to contact your employers.CheckboxExcludeDe NoContact6Check if you do NOT want us to contact your employers.CheckboxExclude$$If!vh5")#v"):V l05")/  / 4aT$$If!vh5")#v"):V l05")/ 4aTD JobTitleP2 Title case&Type the job title on the announcementD GradeApplyP2#Type the grade you are applying forD AnnounceNumP2$Please enter the announcement number$$If!vh5 5d 5:#v #vd #v::V l05 5d 5:/ / / 4aTD LastNameP2Enter your last nameD FirstNameP2 Enter your first and middle nameD SSANP2 ###-##-####!Enter your Social Security Number$$If!vh5@ 5 5:#v@ #v #v::V l05@ 5 5:/ / / 4aTD MailAddressP2Enter your mailing address$$If!vh55:#v#v::V l0055:/  / / / 4aTDCityP2Enter your city.DStateP2Enter your stateDZipP2Enter your zipcode$$If!vh5 5d 5:#v #vd #v::V l05 5d 5:/ / / 4aT$$If!vh5")#v"):V l 05")/  / 4aTDText12!Enter your most recent job title.$$If!vh5")#v"):V l05")/  / 4aT DText13MM/YYYYDEnter your start date at this position, month and year ex. (11/1997)DText14MM/YYYYBEnter your end date at this position, month and year ex. (11/1997)DText15Enter your pay rate.DText16Enter frequency of pay.DText17(Enter the number of hours worked weekly.$$If!vh5 555#v #v#v#v:V l05 555/ /  / 4aTD EmployerInfo.Enter employer's name and employer's address.DText18Enter supervisors name.DText58 Enter supervisor's phone number.$$If!vh55#v#v:V l@055/  / / 4aTDText228Enter a description of your duties and responsibilities.$$If!vh5")#v"):V l 05")/  4aTvDText12$$If!vh5")#v"):V l 05")/  4aTvDText13vDText14vDText15vDText16vDText17$$If!vh5 555#v #v#v#v:V l05 555/ / 4aTvDText23vDText18vDText19$$If!vh55#v#v:V l,055/  / / 4aTvDText22$$If!vh5")#v"):V lp05")/  4aT$$If!vh5")#v"):V l05")/  / 4aT$$If!vh5")#v"):V l05")/ 4aTD JobTitleP3 Title case&Type the job title on the announcementD GradeApplyP3#Type the grade you are applying forD AnnounceNumP3$Please enter the announcement number$$If!vh5 5d 5:#v #vd #v::V l05 5d 5:/ / / 4aTD LastNameP3Enter your last nameD FirstNameP3 Enter your first and middle nameD SSANP3 ###-##-####!Enter your Social Security Number$$If!vh5@ 5 5:#v@ #v #v::V l05@ 5 5:/ / / 4aTD MailAddressP3Enter your mailing address$$If!vh55:#v#v::V l0055:/  / / / 4aTDCityP3Enter your city.DStateP3Enter your stateDZipP3Enter your zipcode$$If!vh5 5d 5:#v #vd #v::V l05 5d 5:/ / / 4aT$$If!vh5")#v"):V l 05")/  / 4aTDText12!Enter your most recent job title.$$If!vh5")#v"):V l05")/  / 4aT DText13MM/YYYYDEnter your start date at this position, month and year ex. (11/1997)DText14MM/YYYYBEnter your end date at this position, month and year ex. (11/1997)DText15Enter your pay rate.DText16Enter frequency of pay.DText17(Enter the number of hours worked weekly.$$If!vh5 555#v #v#v#v:V l05 555/ /  / 4aTD EmployerInfo.Enter employer's name and employer's address.DText18Enter supervisors name.DText58 Enter supervisor's phone number.$$If!vh55#v#v:V l@055/  / / 4aTDText228Enter a description of your duties and responsibilities.$$If!vh5")#v"):V l 05")/  4aTvDText12$$If!vh5")#v"):V l 05")/  4aTvDText13vDText14vDText15vDText16vDText17$$If!vh5 555#v #v#v#v:V l05 555/ / 4aTvDText23vDText18vDText19$$If!vh55#v#v:V l,055/  / / 4aTD Describet TabSlowly$$If!vh5")#v"):V lp05")/  4aT$$If!vh5")#v"):V l05")/  / 4aT$$If!vh5")#v"):V l05")/ 4aTDeA HighSchool5Check if high school is the highest degree completed.CheckboxExcludeDeGED8Check if high school through GED is your highest degree.CheckboxExcludeDeAssoc5Check if an Associates degree is your highest degree.CheckboxExcludeDeBach3Check if a Bachelors degree is your highest degree.CheckboxExcludeDeMaster*Check if a Masters degree is your highest.CheckboxExcludeDeDoctor+Check if a Doctoral degree is your highest.CheckboxExclude$DHighSchoolNameOPlease enter the name of the last high school you attended (address, etc. too).$$If!vh5&(#v&(:V l@05&(4T$$If!vh5&(#v&(:V l05&(/  4T0$$If!vh5 5$ 5N 5#v #v$ #vN #v:V l05 5$ 5N 5/  / / / /  / / / 4TDText34#Enter college or university's name.t$$If!vh5 5F55N 5#v #vF#v#vN #v:V l05 5F55N 5/  / / / /  / / / / / /  4T,$$If!vh5555F55N 5#v#v#v#vF#v#vN #v:V l05555F55N 5/ / / 4TDText35%Enter the city the school is located.DText36&Enter the state the school is located.DText37Enter the school's zip code.D Text380+Enter the total number of credit completed.DText39+Enter the total number of credit completed.DText40Enter your major.DText41Enter the year you graduated.0$$If!vh5555F55N 5#v#v#v#vF#v#vN #v:V l05555F55N 5/ / / 4TDText42#Enter college or university's name.$$If!vh5 5#v #v:V l05 5/ 4TD%Enter the city the school is located.D&Enter the state the school is located.DEnter the school's zip code.D+Enter the total number of credit completed.D+Enter the total number of credit completed.DEnter your major.DEnter the year you graduated.0$$If!vh5555F55N 5#v#v#v#vF#v#vN #v:V l05555F55N 5/ / / 4TDText43#Enter college or university's name.$$If!vh5 5#v #v:V l05 5/ 4TD%Enter the city the school is located.D&Enter the state the school is located.DEnter the school's zip code.D+Enter the total number of credit completed.D+Enter the total number of credit completed.DEnter your major.DEnter the year you graduated.0$$If!vh5555F55N 5#v#v#v#vF#v#vN #v:V l05555F55N 5/ / / 4TDText44 TabSlowly$$If!vh5")#v"):V l05")4TdDe YesCitizenYCheck if you are NOT a U.S. citizen. Hit TAB to fill in the country of your citizenship.CheckboxExcludeCitReinstatebDe NoCitizenYCheck if you are NOT a U.S. citizen. Hit TAB to fill in the country of your citizenship.CheckboxExcludeCitReinstateDCountry(Fill in the country of your citizenship.De NoVeteran7Click if you do not want to claim veteran's preference.CheckboxExcludeVetPriorFedVDe YesVeteranSClick if you want to claim veteran's preference. Then mark your point claim below.CheckboxExcludeVetPriorFedDePoint55Click if you want claim a 5 point veteran preference.DePoint109Click if you want to claim a 10 point veteran preference.2De NoPriorFedAClick if you were not employeed by the federal government before.CheckboxExcludeVetPriorFed De YesPriorFed7Click if you were a federal civilian employee before. CheckboxExcludeVetPriorFedD PriorSeries4Type in the series of your prior federal employment.D PriorGrade1Enter the grade of your prior federal employment.D PriorFromMM/YYYY6Enter the start date of your prior federal employment.DPriorToMM/YYYY4Enter the end date of your prior federal employment.$$If!vh5h5B5#5#vh#vB#v##v:V l05h5B5#54aDe NoReinstate3Click No if you are not eligible for reinstatement.CheckboxExcludeCitReinstateDe YesReinstateCheckboxExcludeCitReinstate8@8 Normal_HmH sH tH DAD Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List -:   UHIe}24Oijz %UV]^_u&'Je   Eabc{  -.Rf%> 5 6 R j   ! < V W g { | } ~ n o p  + a b q Gbcd,bcr   TUVWX ":;Sklmy#7P\]^t%&I]>Z[\t&'K`~ !"xyP78DYbpq   4IJcdeyz{ #$%6J_`tvw5 6 e!!!"""##*#+#u####$$%%%%%%3&Q&S&T&h&i&((())++X,Y,,,n-o-------..//0044y8z8:::0000000 000 000 0 00 000 00 0  000 000 0 00 000 00 0 0 00 0 00 0 00 00 000 00 0 00 000 0 000 0 000 0 00 00 000 00 0 00 00000 0 00 0 00 0 00 0 0000 000 000 0 00 000 00 0  000 0 0 00 000 0 0 0 00 0 00 0 00 00 000 00 0 00 000 0 000 0 000 0 00 00 000 00 0 00 00000 0 00 0 0 0 00 0 00000 000 000 0 00 000 00 0  000 0 0 00 000 0 0 0 00 0 00 0 00 00 000 00 0 00 000 0 000 0 000 0 00 00 000 00 0 00 00000 0 00 0 0 0 00 0 0000x00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 000 0 0 00 0 0 0 0 0 0 0 000 0 0 00 0 0 0 0 0 0 0 000 0 0 00 0 0 0 0 0 000 @0 00000x00000000 0 0 0 0 0000x000000000000000000 00 00 00 00 00 000000\>000 00 00 00 00 000 "(j # (*2.1t59z:|;|< @C^2"'+.259=AEIMQUX\_bef 44$(  4 ""$%'()4**,-.0023578<9n99::;<4=s? 2#%&()*,-/0134678:;<>?@BCDFGHJKLNOPRSTVWYZ[]^`acd2$iu{*0T`fz %17AMSkw}IU[|$Q]cMY_%+R^d+;?OV b h   A M S g s y  - 9 ? L X ^ q } NZ` .:@MY_r~ @LR&28Wci}#/5P\blx~HTZ{#IU[FRX|$LX^ 0>Nq}   ,25AGO[aeqw{ !%146BHKW]`lrtw! - 3 b r !!"*"3"C""""""#####"#(#####:FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFtG$G$FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFtG G G G G G FFFFFFFFFFFFFFFFFFFFFFFFFFtG$G$F4G$G$G$G$G$G$FFFFG$G$8@(  VB  C D"B S  ?%:a0*atPJobTitle GradeApply AnnounceNumLastName FirstNameSSAN MailAddressText11CityStateZipText10Text12Text13Text14Text15Text16Text17 EmployerInfoText18Text58Text22Text23Descriob YesContact NoContact JobTitleP2 GradeApplyP2 AnnounceNumP2 LastNameP2 FirstNameP2SSANP2 MailAddressP2CityP2StateP2ZipP2 JobTitleP3 GradeApplyP3 AnnounceNumP3 LastNameP3 FirstNameP3SSANP3 MailAddressP3CityP3StateP3ZipP3 Describet HighSchoolGEDAssocBachMasterDoctorHighSchoolNameText34Text35Text36Text37Text38Text39Text40Text41Text42Text43Text44 YesCitizen NoCitizenCountry NoVeteran YesVeteranPoint5Point10 NoPriorFed YesPriorFed PriorSeries PriorGrade PriorFromPriorTo NoReinstate YesReinstatejU{&BlJ}RS,@W B h 'X~$Qm!?r !6Px" c !"4"""####:  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNO|1g 8T~\%de<Pi  T z 9j6c1O 3Hb 4 s !+"D""##)###:ٽ\ڽ $  Y  t u Z,۽\dJT : 9L n|;̟ [[4&4&*+++8x:x::::      __8&8&*++,8::::: >*urn:schemas-microsoft-com:office:smarttags PostalCode9*urn:schemas-microsoft-com:office:smarttagsState8*urn:schemas-microsoft-com:office:smarttagsCity8*urn:schemas-microsoft-com:office:smarttagstime9*urn:schemas-microsoft-com:office:smarttagsplaceB*urn:schemas-microsoft-com:office:smarttagscountry-region8 *urn:schemas-microsoft-com:office:smarttagsdate  01012151959197631DayHourMinuteMonthYear       !!55:9B!!""#$ $$]%e%8899:3333333333I2z f|'Qec.Rf6 V j  g ~ N p  q r &;Wm}#7e{&I]\|'L`8q 4eJ`>w::! /e 3 "  _: k Z7 y>~<@ХBuCz.Ը.LEB!FdDqkiM^iZ++/Ul:V e_Vmoֱ/mo| u3(sl:V" /e.LE4XRI}4ij V^_&'e  bc -.f 5 6 j ! V W | } ~ o p  b cdc  UVWX ;lm7]^%&][\&'` !yP78DYbpq  4IJcde{ %6J`tv""##*#+##%::@v{h Hvv@{xvvvvvvvvc c c c ccc |":@ 0@ "$L@(*,.02h@68:<|@@@UnknownGz Times New Roman5Symbol3& z Arial"qhډ&ډ&1j1j24dx:x:'3H)?4XP:\PUBLIC\forms\OF-612.DOT Form Approved yodominguez yodominguez\               Oh+'0 $ @ L X dpxForm Approvedoorm yodominguezodoodo OF-612.DOT yodominguez2doMicrosoft Word 10.0@ԭ@@<3a@U1՜.+,0 hp  USAIDpjx: Form Approved Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~    Root Entry FlData <1TableiWordDocumentCSummaryInformation(DocumentSummaryInformation8 CompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q