Standard Form 171-A - Continuation Sheet For Sf 171

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Standard Form 171-A Continuation Sheet for SF 171

Form Approved:

OMB No. 3206-0012

Attach all SF 171-A's to your application at the top of page 3.

1. Name (Last, First, Middle Initial)

2. Social Security Number

3. Job Title or Announcement Number You Are Applying For

4. Date Completed

ADDITIONAL WORK EXPERIENCE BLOCKS

N am e and ad dr ess of employer's organization(include ZIP Code, if known)

Dates employed (give month, day and year)

Average number of

Number of employees

hours per week

you supervise

From:

To:

Salary or earnings

Your reason for wanting to leave

Starting $

per

Ending $

per

Your immediate supervisor

Exact title of your job

If Federal employment (civilian or military) list series, grade

N a me

Te l eph

phone No.

or rank, and, if promoted in this job, the date of your last

promotion

Description of work: Describe your specific duties, responsibilities and accomplishments in this job, including the job title(s) of any employees you supervise. If you describe

more than one type of work (for example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.

For Agency Use (skill codes, etc.)

Name and address of employer's organization (include ZIP Code, if known)

Dates employed (give month, day and year)

Average number of

Number of employees

hours per week

you supervise

From:

To:

Salary or earnings

Your reason for leaving

Starting $

per

Ending $

per

Your immediate supervisor

Exact title of your job

If Federal employment (civilian or military) list series, grade

N a me

Te l eph on e N o .

or rank, and, if promoted in this job, the date of your last

promotion

Description of work: Describe your specific duties, responsibilities and accomplishments in this job, including the job title(s) of any employees you supervise. If you describe

more than one type of work (for example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.

For Agency Use (skill codes, etc.)

THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER

Standard F orm 171-A ( Rev. 6-88)

PREVIOUS EDITION USABLE UNTIL 12-31-90

U.S. Office of Personnel Management

NSN 7540-00-935-7157

171-206

FPM Chapter 295

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