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PART II - PRIVACY ACT STATEMENT AND CERTIFICATION

The Office of Personnel Management is authorized by section 1302 of Chapter 12 (Special Authority) and sections 3301 and 3304 of Chapter 33 (Examination, Certification, and

Appointment:) of Title 5 of the U.S. Code to collect the information on this form.

Executive Order 9397 (Numbering System for Federal Accounts Relating to Individual Persons) authorizes the collection of your Social Security Number (SSN). Your SSN is used to

identify this form with your basic application. It may be used for the same purposes as stated on the application.

The information you provide will be used primarily to determine your qualifications for Federal employment. Other possible uses or disclosures of the information are:

1. To make requires for information about from any source; (e.g., former employers or schools).that would assist an agency in determining whether to hire you.

2. To refer your application to prospective Federal Employers and, with your consent, to others (e.g., State and local governments) for possible employment.

3. To a Federal, State, or local agency for checking on violations of law or other lawful purposes in connection with hiring or retaining you on the job, or issuing you a security clearance;

4. To the courts when the Government is party to a suit; and

5. When lawfully required by Congress, the Office of Management and Budget, or the General Services Administration.

Providing the information requested on this form, including your SSN is voluntary. However, failure to do so may result in your not receiving an accurate rating, which may hinder your

chances for obtaining Federal employment.

PUBLIC BURDEN INFORMATION:

Public burden reporting for this collection of information is estimated to take approximately 40 minutes per response, including time for review instructions, searching existing data

sources, gathering and maintaining the data needed, and completing and reviewing the collection information. Send comments regarding the burden estimate or any other aspect of this

collection of information, including suggestions for reducing this burden to Reports and Forms Management Office, U.S. Office of Personnel Management, 1900 E Street N.W., Room

CHP 500 Washington, D.C. 20415; and to the Office of Management and Budget, Paperwork Reduction Project (3200-0038), Washington, D.C. 20503.

ATTENTION - THIS STATEMENT MUST BE SIGNED

Read the following paragraph carefully before signing this statement

A false answer to any question in this Statement can be grounds for not employing you, or for dismissing you after you begin work, and may be punishable by fine

or imprisonment (US Code, Title 18, Sec 1001). All statements are subject to investigation, including a check of your fingerprints, police records, and former

employers. All the information you give will be considered in reviewing your Statement and is subject to investigation

CERTIFICATION

Signature (Sign in ink)

Date Signed

I CERTIFY that all of the statements made in this Statement

are true, complete, and correct to the best of my knowledge

and belief, and are made in good faith .

COMPLETE PART III ON THE NEXT PAGE IF YOU CLAIM SUPERIOR ACADEMIC ACHIEVEMENT