Complete the form as follows:
| Block 1 |
Title of position and announcement number as shown
on vacancy announcement, and the position category
code.
(Example: Teacher, AD-1710-00, 07-BEN-25-ESP.
The category code "ESP" would designate
Teacher - Pre-Kindergarten.) |
| Block 2 |
Name, (Last, First, Middle Initial) (DOE, John E.) |
| Block 3 |
Social Security Number (999-99-9999) |
| Block 4 |
Indicate your birthplace (city and state or country). |
| Block 5 |
Enter your email address. |
| Block 6 |
Current mailing address (where you can be contacted
or notified of the results of your application). |
| Block 7 |
List other names used; e.g., maiden name, nickname,
etc. |
| Block 8 |
Provide home and work telephone numbers. |
| Block 9 |
Check appropriate box(es). |
| Block 10 |
Indicate if you are claiming
Veteran's Preference.
- You must submit
a copy of your DD214 and Veterans Preference
Checklist to receive preference.
- Standard
Form-15 must also
be provided if claiming 10-point
veteran preference.
|
| Block 11 |
Indicate if you are claiming Military Spouse
Preference. To receive preference you must:
- be the
spouse of an active duty military member of the
Armed Forces, including a member of the U.S.
Coast Guard,
- be relocating because of permanent
change of station orders.
- Submit the Military
Spouse Employment Request form (pdf) with
application.
|
| Block 12 |
Self-explanatory. |
| Block 13 |
Check appropriate box(es) |
| Block 14 |
Self-explanatory. |
| Block 15 |
Indicate highest educational level attained. |
| Block 16 |
Self-explanatory. |
| Block 17 |
Indicate colleges and universities attended. |
| Block 18 |
Write a clear and brief, but complete, description
of your work experience as it pertains to the positions
you are applying for. Include (month/year) and identify
work experience described. We may verify your work
experience with your former employers. |
| Block 19 |
Self-explanatory. |
| Block 20 - 32 |
Read the note preceding blocks 20 - 32 then read
each question carefully and provide all information
requested, as applicable. |
| Signature Block |
You must sign and date. |