ࡱ> [ Objbj {jj).ylJJJJJNV4hx 2Bb.#2#2#6#$G+.%@'@'@'@'@'@'@$,C LEK@J0$"$00K@0JJ6#6#KA0000J6#J6#%@"C 00%@00q4JJq46# +z160q4q4 B02Bq4E0Eq40."JJJJGENERAL 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 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, 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 you application to the office announcing the vacancy. If you have questions, contact that office. THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER  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 this collection 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. Form 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. 1Job title in announcement2Grade(s) applying for3Announcement number FORMTEXT       FORMTEXT       FORMTEXT      4Last nameFirst and middle names5Social Security Number FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT     -  FORMTEXT    -  FORMTEXT     6Mailing address7Phone numbers (include area code) FORMTEXT      Daytime ( FORMTEXT    )  FORMTEXT      FORMTEXT     CityStateZIP Code FORMTEXT       FORMTEXT    FORMTEXT       -  FORMTEXT     Evening( FORMTEXT    )  FORMTEXT      FORMTEXT      WORK EXPERIENCE 8Describe your paid and nonpaid work experience related to the job for which you are applying. Do not attach job descriptions.Job title (if Federal, include series and grade)  1) FORMTEXT      From (MM/YY)To (MM/YY)SalaryperHours per week FORMTEXT     FORMTEXT      FORMTEXT     FORMTEXT     $ FORMTEXT       FORMTEXT       FORMTEXT      Employer s name and addressSupervisor s name and phone number FORMTEXT       FORMTEXT       FORMTEXT      ( FORMTEXT    )  FORMTEXT      FORMTEXT     Describe your duties and accomplishments FORMTEXT      Job title (if Federal, include series and grade) 2) FORMTEXT      From (MM/YY)To (MM/YY)SalaryperHours per week FORMTEXT     FORMTEXT      FORMTEXT     FORMTEXT     $ FORMTEXT       FORMTEXT       FORMTEXT      Employer s name and addressSupervisor s name and phone number FORMTEXT       FORMTEXT       FORMTEXT      ( FORMTEXT    )  FORMTEXT      FORMTEXT     Describe your duties and accomplishments FORMTEXT       9May we contact your current supervisor?YES  FORMCHECKBOX NO  FORMCHECKBOX  symbol 232 \f "Monotype Sorts" \s 9If we need to contact your current supervisor before making an offer, we will contact you first. EDUCATION 10Mark highest level completed.Some HS  FORMCHECKBOX HS/GED  FORMCHECKBOX Associate  FORMCHECKBOX Bachelor  FORMCHECKBOX Master  FORMCHECKBOX Doctoral  FORMCHECKBOX  11Last high school (HS) or GED school. Give the schools name, city, State, ZIP Code (if known), and year diploma or GED received. FORMTEXT      12Colleges and universities attended. Do not attach a copy of your transcript unless requested.NameTotal Credits EarnedMajor(s)Degree -Year1) FORMTEXT      SemesterQuarter(if any)ReceivedCityStateZIP Code FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT    FORMTEXT       -  FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      2) FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT    FORMTEXT       -  FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      3) FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT    FORMTEXT       -  FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       OTHER QUALIFICATIONS 13Job-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 14Are you a U.S. citizen?YES FORMCHECKBOX NO FORMCHECKBOX symbol 232 \f "Monotype Sorts" \s 9Give the country of your citizenship. FORMTEXT      15Do you claim veterans preference?NO FORMCHECKBOX YES FORMCHECKBOX symbol 232 \f "Monotype Sorts" \s 9Mark your claim of 5 or 10 points below.5 points FORMCHECKBOX symbol 232 \f "Monotype Sorts" \s 9Attach your DD 214 or other proof.10 points FORMCHECKBOX symbol 232 \f "Monotype Sorts" \s 9Attach an Application for 10-Point Veterans Preference (SF 15) and proof required.16Were you ever a Federal civilian employee?SeriesGradeFrom (MM/YY)To (MM/YY)NO FORMCHECKBOX YES FORMCHECKBOX symbol 232 \f "Monotype Sorts" \s 9For highest civilian grade give: FORMTEXT       FORMTEXT       FORMTEXT     FORMTEXT      FORMTEXT     FORMTEXT     17Are you eligible for reinstatement based on career or career-conditional Federal status?NO FORMCHECKBOX YES FORMCHECKBOX symbol 232 \f "Monotype Sorts" \s 9If requested, attach SF 50 proof. APPLICANT CERTIFICATION 18I 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 firing me after I begin work, and may be punishable by fine or imprisonment. I understand that any information I give may be investigated. 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Linda M. Hurt'D:\MSOFC43\WINWORD\TEMPLATE\RESCUE2.DOT Linda M. Hurt'D:\MSOFC43\WINWORD\TEMPLATE\RESCUE2.DOT Linda M. Hurt'D:\MSOFC43\WINWORD\TEMPLATE\RESCUE2.DOC Linda M. Hurt'D:\MSOFC43\WINWORD\TEMPLATE\RESCUE2.DOC Linda M. Hurt%D:\MSOFC43\WINWORD\TEMPLATE\OF612.DOC Linda M. HurtH:\FORMS\OF612.DOC Linda M. HurtH:\FORMS\OF612.DOC Linda M. HurtH:\FORMS\OF612.DOC Linda M. HurtH:\FORMS\OF612.DOCFrancisco J. 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Apodaca92anMicrosoft Word 9.0a@@@rvz1@rvz1&՜.+,0 hp|  LOCQ.2 Form Approved Title  FMicrosoft Word Document MSWordDocWord.Document.89qxx0.K2V  Form Approved Linda M. HurtFrancisco J. Apodaca