Ps Form 2591 - Application For Employment Form Page 3

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Name (First, MI, Last)

Social Security No.

Date

Dates of Employment (Month & Year)

Grade If Postal, Federal Service or Military

Starting Salary/Earnings

From

per

Exact Position Title

Average Hours per Week

Number and Kind of Employees Supervised

Present Salary/Earnings

per

Name of Employer and Complete Mailing Address

Kind of Business (Manufacturing, etc.)

Place of Employment (City & State)

Name of Supervisor

Telephone No. (If known)

(

)

Reason for Leaving

Description of Duties, Responsibilities, and Accomplishments

D. Veteran Preference (Answer all parts. If a part does not apply, answer "No".)

Yes

1. Have you ever served on active duty in the US military service? (Exclude tours of active duty for training

as a reservist or guardsman.)

2. Have you ever been discharged from the armed service under other than honorable conditions? You may

omit any such discharge changed to honorable by a Discharge Review Board or similar authority.

(If "Yes," give details in Section F.)

3. Do you claim 5-point preference based on active duty in the armed forces? (If "Yes," you will be required to

furnish records to support your claim.)

4. Do you claim a 10-point preference? If "Yes," check type of preference claimed and attach Standard Form

15, Claim for 10-Point Veteran Preference, together with proof called for in that form.

Compensable Disability

Non-Compensable

Wife/Husband

(Less than 30%)

(30% or more)

Disability (includes Receipt

of the Purple Heart)

Widow/Widower

Mother

Other:

5. List for All Military Service: (Enter N/A if not applicable)

Date (From - To)

Serial/Service Number

Branch of Service

Type of Discharge

THE LAW (39 U.S. CODE 1002) PROHIBITS POLITICAL AND CERTAIN OTHER RECOMMENDATIONS FOR APPOINTMENTS, PROMOTIONS, ASSIGNMENTS,

TRANSFERS, OR DESIGNATIONS OF PERSONS IN THE POSTAL SERVICE. Statements relating solely to character and residence are permitted, but every other kind of

statement or recommendation is prohibited unless it either is requested by the Postal Service and consists solely of an evaluation of the work performance, ability, aptitude,

and general qualifications of an individual or is requested by a government representative investigating the individual’s loyalty, suitability, and character. Anyone who

requests or solicits a prohibited statement or recommendation is subject to disqualification from the Postal Service and anyone in the Postal Service who accepts such a

statement may be suspended or removed from office.

Privacy Act Statement: The collection of this information is authorized by 39 USC 401 and 1001. This information will be used to determine your qualifications and suitability

for USPS employment. As a routine use, the information may be disclosed to an appropriate government agency, domestic or foreign, for law enforcement purposes; where

pertinent, in a legal proceeding to which the USPS is a party or has an interest; to a government agency in order to obtain information relevant to a USPS decision

concerning employment, security clearances, contracts, licenses, grants, permits or other benefits; to a government agency upon its request when relevant to its decision

concerning employment, security clearances, security or suitability investigations, contracts, licenses, grants or other benefits; to a congressional office at your request; to an

expert, consultant, or other person under contract with the USPS to fulfill an agency function; to the Federal Records Center for storage; to the Office of Management and

Budget for review of private relief legislation; to an independent certified public accountant during an official audit of USPS finances; to an investigator, administrative judge or

complaints examiner appointed by the Equal Employment Opportunity Commission for investigation of a formal EEO complaint under 29 CFR 1613; to the Merit Systems

Protection Board or Office of Special Counsel for proceedings or investigations involving personnel practices and other matters within their jurisdiction; and to a labor

organization as required by the National Labor Relations Act. Completion of this form is voluntary; however, if this information is not provided, you may not receive full

consideration for a position.

COMPUTER MATCHING: Limited information may be disclosed to a federal, state, or local government administering benefits or other programs pursuant to statute for the

purpose of conducting computer matching programs under the Act. These programs include, but are not limited to, matches performed to verify an individual’s initial or

continuing eligibility for, indebtedness to, or compliance with requirements of a benefit program.

2591

PS Form

, March 1999 (Page 3 of 4)