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OPTIONAL APPLICATION FOR FEDERAL EMPLOYMENT
(OF 612 -- Form Approved: OMB No. 3206-021)
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.
(Send your application to the agency announcing the vacancy.)
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1. JOB TITLE IN ANNOUNCEMENT:
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2. GRADE(S) APPLYING FOR:
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3. ANNOUNCEMENT NUMBER:
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4. LAST NAME: FIRST, MIDDLE:
-------------------- ----------------------
5. SOCIAL SECURITY NUMBER: - -
------- ---- -------
6. MAILING ADDRESS:
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CITY/STATE/ZIP:
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7. PHONE NUMBERS (include area code) DAYTIME:
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EVENING:
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8. WORK EXPERIENCE: Describe your paid and nonpaid work experience
related to the job for which you are applying. (Do not attach job
descriptions)
1) JOB TITLE (If Federal,
include series and grade): ----------------------------------------
FROM (MM/YY): TO (MM/YY):
------------ ------------
SALARY: $ per HOURS PER WEEK:
------------ -------- --------
EMPLOYER'S NAME:
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AND ADDRESS:
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SUPERVISOR'S NAME:
---------------------------------
AND PHONE:
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DESCRIBE YOUR DUTIES AND ACCOMPLISHMENTS:
2) JOB TITLE (If Federal,
include series and grade): ----------------------------------------
FROM (MM/YY): TO (MM/YY):
------------ ------------
SALARY: $ per HOURS PER WEEK:
------------ -------- --------
EMPLOYER'S NAME:
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AND ADDRESS:
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SUPERVISOR'S NAME:
---------------------------------
AND PHONE:
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DESCRIBE YOUR DUTIES AND ACCOMPLISHMENTS:
9. MAY WE CONTACT YOUR CURRENT SUPERVISOR? (If we need to YES [ ]
contact your current supervisor before making an offer,
we will contact you first.) NO [ ]
EDUCATION
Some HS [ ] Bachelor [ ]
10. MARK HIGHEST LEVEL COMPLETED: HS/GED [ ] Master [ ]
Associate [ ] Doctoral [ ]
11. LAST HIGH SCHOOL or GED SCHOOL:
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CITY/STATE/ZIP(if ZIP known):
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YEAR DIPLOMA or GED RECEIVED:
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12. COLLEGES AND UNIVERSITIES ATTENDED (Do not attach a copy of your
transcript unless requested.)
1) NAME:
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CITY/STATE/ZIP:
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SEMESTER CREDITS EARNED: MAJOR(S):
(or) ------ ---------------------
QUARTER CREDITS EARNED:
------ ---------------------
DEGREE (If any): YEAR RECEIVED:
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2) NAME:
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CITY/STATE/ZIP:
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SEMESTER CREDITS EARNED: MAJOR(S):
(or) ------ ---------------------
QUARTER CREDITS EARNED:
------ ---------------------
DEGREE (If any): YEAR RECEIVED:
------------------------- -------
3) NAME:
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CITY/STATE/ZIP:
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SEMESTER CREDITS EARNED: MAJOR(S):
(or) ------ ---------------------
QUARTER CREDITS EARNED:
------ ---------------------
DEGREE (If any): YEAR RECEIVED:
------------------------- -------
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OTHER QUALIFICATIONS
13. 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.
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GENERAL:
14. ARE YOU A U.S. CITIZEN? ........................ YES [ ] NO [ ]
If NO, give the country of your citizenship:
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15. DO YOU CLAIM VETERANS' PREFERENCE? ............. YES [ ] NO [ ]
If YES, mark your claim of 5 or 10 points below:
5 POINTS [ ] -- Attach your DD 214 or other proof.
10 POINTS [ ] -- Attach an Application for 10-Point Veterans'
Preference (SF 15) and proof required.
16. WERE YOU EVER A FEDERAL CIVILIAN EMPLOYEE? ..... YES [ ] NO [ ]
If YES, for Highest Civilian Grade give:
SERIES: GRADE: FROM (MM/YY): TO (MM/YY):
------- ----- ------ ------
17. ARE YOU ELIGIBLE FOR REINSTATEMENT BASED ON
CAREER OR CAREER-CONDITIONAL FEDERAL STATUS? ... YES [ ] NO [ ]
If requested, attach SF 50 proof.
APPLICANT CERTIFICATION
18. 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 fraud-
ulent information on or attached to this application may be grounds
for not hiring me or for firing me after I begin work, and may be
punishable by fine or imprisonment. I understand that any informa-
tion I give may be investigated.
SIGNATURE: DATE SIGNED:
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GENERAL INFORMATION
* You may apply for most Federal jobs with a resume, this 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 in 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 the 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 veterans'
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 or
when competition is limited to status candidates (current or
former career or career-conditional Federal employees).
* Most Federal jobs require United States citizenship and also that
males over age 18 born after December 31, 1959, be registered
with the Selective Service System or have an exemption.
* The law prohibits public official 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.
THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER.
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PRIVACY ACT AND PUBLIC BURDEN STATEMENTS
The Office of Personnel Management and other Federal agencies rate
applicants 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. Your SSN may also
be used in studies and computer matching with other Government files,
for example, files on unpaid student loans.
If you do not give us your SSN or any other information requested, we
cannot process your application, which is the first step in getting a
job. Also, incomplete addresses and ZIP Codes will slow processing.
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 of law or regulation; Federal agencies for
statistical reports and studies; officials of labor organizations
recognized by law in connection with representing employees; Federal
agencies or other sources requesting information for Federal agencies
in connection 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 Labor Relations Authority, the National
Archives, 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 individuals
concerning the home address and other relevant information on those
who might have contracted an illness or been exposed to a health
hazard; authorized Federal and nonfederal agencies for use in computer
matching; spouses or dependent children asking whether the employee
has changed from 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 the employment information
will vary from 20 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 comments 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
20415-0001.
Send your application to the agency announcing the vacancy.