Application For Federal Employment-Sf 171

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Application for Federal Employment--SF 171
Retrieve Data
Reset Form
Form Approved:
OMB No. 3206-0012
Read the instructions before you complete this application. Type or print clearly in dark ink.
GENERAL INFORMATION
DO NOT WRITE IN THIS AREA
1
What kind of job are you applying for? Give title and announcement no. (if any)
FOR USE OF EXAMINING OFFICE ONLY
Date entered register
2
3
Social Security Number
Sex
Form reviewed:
//
Form approved:
Male
Female
4
5
Birth date (Month, Day, Year)
Birthplace (City and State or Country)
Earned
Veteran
Augmented
Option
Grade
Rating
Preference
Rating
//
No
6
Name (Last, First, Middle)
Preference
Claimed
5 Points
Mailing address (include apartment number, if any)
(Tentative)
10 Pts. (30%
City
State
ZIP Code
Or More
Comp. Dis.)
10 Pts. (Less
Than 30%
Comp. Dis.)
7
Other names ever used (e.g., maiden name, nickname, etc.)
Other
10 Points
Initials and Date
Being
//
8
9
Home Phone
Work Phone
Disallowed
Investigated
Area Code
Number
Area Code
Number
Extension
FOR USE OF APPOINTING OFFICE ONLY
Preference has been verified through proof that the separation
was under honorable conditions, and other proof as required.
10
Were you ever employed as a civilian by the Federal Government? If "NO", go to
10-Point-- 30% or More
10-Point-- Less Than 30%
Item 11. If "YES", mark each type of job you held with an "X".
5-Point
10-Point--Other
Compensable Disability
Compensable Disability
Signature and Title
Temporary
Career-Conditional
Career
Excepted
What is your highest grade, classification series and job title?
Agency
Date
//
Dates at highest grade: FROM
TO
AVAILABILITY
MILITARY SERVICE AND VETERAN PREFERENCE (Cont.)
11
12
19
When can you start work?
What is the lowest pay you will accept? (You
Were you discharged from the military service under honorable
YES
NO
(Month and Year)
will not be considered for jobs which pay less
conditions? (If your discharge was changed to "honorable" or
than you indicate.)
"general" by a Discharge Review Board, answer "YES". If you
Pay $
per
OR Grade
received a clemency discharge, answer "NO".)
13
In what geographic area(s) are you willing to work?
If "NO", provide below the date and type of discharge you received.
Discharge Date
Type of Discharge
(Month, Day, Year)
//
14
20
Are you willing to work:
List the dates (Month, Day, Year) , and branch for all active duty military service.
YES
NO
From
To
Branch of Service
//
//
A. 40 hours per week (full-time)? ............................
//
//
B. 25-32 hours per week (part-time)? .....................
21
If all your active military duty was after October 14, 1976, list the full names and
C. 17-24 hours per week (part-time)? .....................
dates of all campaign badges or expeditionary medals you received or were
D. 16 or fewer hours per week (part-time)? ............
entitled to receive.
E. An intermittent job (on-call/seasonal)? ...............
F. Weekends, shifts, or rotating shifts?...................
15
22
Are you willing to take a temporary job lasting:
Read the instructions that came with this form before completing this item.
When you have determined your eligibility for veteran preference from the
A. 5 to 12 months (sometimes longer)? ..................
instructions, place an "X" in the box next to your veteran preference claim.
B. 1 to 4 months?....................................................
NO PREFERENCE
C. Less than 1 month?............................................
5-POINT PREFERENCE -- You must show proof when you are hired.
16
Are you willing to travel away from home for:
10-POINT PREFERENCE -- If you claim 10-point preference, place an "X"
A. 1 to 5 nights each month?..................................
in the box below next to the basis for your claim. To receive 10-point
preference you must also complete a Standard Form 15, Application
B. 6 to 10 nights each month?................................
for 10-Point Veteran Preference, which is available from any Federal
C. 11 or more nights each month?.........................
Job Information Center. ATTACH THE COMPLETED SF 15 AND
MILITARY SERVICE AND VETERAN PREFERENCE
REQUESTED PROOF TO THIS APPLICATION.
17
Have you served in the United States Military Service? If your
YES
NO
only active duty was training in the Reserves or National Guard,
Non-compensably disabled or Purple Heart recipient.
answer "NO". If "NO", go to item 22. ...........................................
Compensably disabled, less than 30 percent.
18
Did you or will you retire at or above the rank of major or lieuten-
Spouse, widow(er), or mother of a deceased or disabled veteran.
ant commander?............................................................................
Compensably disabled, 30 percent or more.
Standard Form 171 (Rev. 6-88)
THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
NSN 7540-00-935-7150
171-110
U.S. Office of Personnel Management
PREVIOUS EDITION USABLE UNTIL 12-31-90
FPM Chapter 295
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