Form Bc-170b - U.s. Census Employment Inquiry Page 4
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519.
Section A – APPLICANT PERSONAL DATA – Con.
Are you now employed by a federal, state, local or tribal
government? – If yes, indicate date of hire and current grade
level in Item 32.
13a.
Education – Mark (X) highest education level.
Some high school – Did not graduate
Yes – Name of agency
High school diploma/GED
No
Technical degree/Trade school degree or certificate
20.
Are you now employed by a law enforcement agency?
Associate’s degree
Yes – Name of agency
Bachelor’s degree
No
Master’s degree
21.
Do you have supervisory experience?
Doctoral degree
Yes – Describe in Item 32.
No
b.
Complete when a Technical/Trade school program,
an Associate’s, Bachelor’s, Master’s or
Degree
Year
22.
Do you receive retirement or have you ever applied for
Doctoral degree is selected in 13a.
(if any)
received
retirement pay, pension, or other pay based on
nonmilitary, federal civilian, or District of Columbia
Name of
Government service?
institution
Yes – Explain in Item 32.
No
City
23.
Do any of your relatives work for the Census Bureau?
Include – Father, mother, husband, wife, son, daughter, brother, sister,
uncle, aunt, first cousin, nephew, niece, father-in-law, mother-in-law,
State or
brother-in-law, sister-in-law, son-in-law, daughter-in-law, stepfather,
country
stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother,
and half sister.
Section B – RECRUITING SOURCES
Yes – Provide location (city and state) and position.
14.
How did you hear about census job opportunities?
Mark (X) one box only.
Poster
Community or organization newsletter/newspaper/leader
No
Federal, state, tribal employment office/
24.
Job service and information center
Hiring may be based in part on the hours you are
available to work. Indicate your availability by placing
Census Recruiter
"X" in the appropriate
Sun Mon Tues Wed Thurs
Fri
Sat
Friend or relative working for Census
box(es) for each day.
Toll-free Census number or job line
a.
Any hours
Census job mailing or postcard
b.
Morning
Friend or relative not working for Census
(8 a.m. – 12 noon)
Job Fair
c.
Afternoon
(12 noon – 4 p.m.)
Newspaper – advertisement
d.
Evening
Newspaper – article
(4 p.m. – 9 p.m.)
Radio
Census field work will usually require you to work evenings and
Internet/E-Mail
weekends.
School or college
Census Job Website
Section D – LANGUAGE SKILLS
TV
25.
Some census jobs require census employees to conduct the census
Brochure/Hand-out
interview by reading and recording responses to questions in a language
other than English. The census employee must also be able to convince
Other – Specify
individuals who speak no English to respond to the interview by explaining
the purpose and importance of the census. Employees will receive
Census training, but not language training.
Are you fluent enough in any specific language to hold a conversation, to
easily read and record responses, as well as to respond to questions in
that language with individuals who speak no English? If so, please list the
language(s) below and mark (X) to all that apply.
Section C – APPLICATION DATA
Language(s)
Speak Read
Write
Most field positions require dealing with the public and
knocking on doors to collect personal information, which
may not be discussed or shared with anyone except for
sworn Census Bureau employees.
15.
Are you willing to work in the field, verifying household
address listings and knocking on doors to collect
Section E – TRANSPORTATION
information?
Yes
No
26a.
Indicate the type(s) of transportation available for your
use – Mark (X) ALL that apply.
Most office positions involve working with computers.
Automobile
16.
Are you willing to work in the office? (There are a
4-Wheel Drive
limited number of these jobs available.)
Airplane
Yes
No
Boat
17.
ATV (All terrain vehicle)
Do you have computer or data entry experience?
Other – Describe
Yes
No
None
18.
Have you ever worked on previous census operations?
b.
Do you have a valid driver’s license?
Yes
No
Yes
No
Page 2
FORM BC-170B (11-27-2012)
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