Roving Regional P and T Advisor Application Form 2023.docx

Revised November 2023

ASSIGNMENT-BASED/ROVING

REGIONAL PROGRAMMING AND TRAINING ADVISOR (RA)

PERSONAL SERVICES CONTRACT

APPLICATION FORM

SOLICITATION #1145PC24R0003

INTERMITTENT ROVING PEACE CORPS MEDICAL OFFICER (PCMO)

PERSONAL SERVICES CONTRACT

APPLICATION FORM

Name

Name

Citizenship(s)_________________________ US Green Card Holder (Yes/No)

Address

E-mail address

Telephone (Day) (Evening)

Interested in Being Considered for (Indicate “Yes” or “No” for Each):

Full-Time RA Positions: Yes |_| No |_|

Intermittent RA Positions: Yes |_| No |_|

1. WORK EXPERIENCE: Submit a resume or CV containing all of the following information, ensuring that it addresses those items listed as “Minimum Requirements” or areas to be evaluated in the RA Personal Services Contractor solicitation:

· All work and/or volunteer experience for the past ten years, including your current position. For each position held, list:

· Start and end dates

· Hours/week worked

· Compensation/salary received

· Full description of duties and responsibilities, including

· Number of persons supervised

· Number and purpose of presentations and/or trainings directed or delivered

· Number/type and purpose of written publications authored

· Last supervisor’s name, title, e-mail address, and telephone number

· Reason for leaving

· Account for any period of unemployment of longer than 3 months within the last 10 years

· Education and/or training received – to include any degrees/credentials earned and the date of conference

· Languages spoken and level of fluency

· Please indicate whether you are able to drive a manual vehicle

2. REQUIRED QUALIFICATIONS: Please complete the two right columns in the following chart.

Has a minimum of seven years of experience in programming and training activities, such as program design and management; volunteer management; monitoring and evaluation; and policy advice and guidance.

Has a minimum of five years of experience providing support to international volunteers, students, or interns.

Has a minimum of five years of experience living and working in transitioning or developing international countries.

Has a minimum of five years of supervisory experience as a first-level supervisor or higher.

Has a minimum of three years of experience developing and leading training on relevant topics for multicultural staff, volunteers, interns, or students.

Has a minimum of two years of experience conducting assessments and preparing written reports.

Able to communicate professionally orally and in writing in English.

Able to appropriately work in confidential situations.

3. QUESTIONS: Please answer the following questions.

3.A. Are you currently or have you ever worked for the Peace Corps as an employee (e.g. US Direct Hire (USDH), Expert, or Foreign Service National (FSN)) or personal services contractor? If yes, please list the location of that work (e.g. post or office of assignment), position title(s), and position date(s).

3.B. In the last ten years have you:

• Been fired from a job?

• Quit after being told you would be fired?

• Left a job by mutual agreement following allegation of misconduct?

• Left by mutual agreement following allegation of unsatisfactory performance?

• Left a job for other reasons under unfavorable circumstances?

3.C. The anticipated personal services contract(s) will be Assignment-Based/Intermittent Roving in nature. The RA will be assigned to a post for all working days of their contract. This will require the RA to travel to the post of assignment and be physically present in the commuting area of that post of assignment for the length of that assignment. Assignments may vary in length (e.g. from a couple of weeks to multiple months). Confirm your availability and willingness to travel on a Roving basis to various Peace Corps overseas posts, often for extended periods of time, throughout the period of performance. Please indicate any known limitations.

4. CONFIRMATIONS

By signing the application below and submitting it to Peace Corps in connection with this solicitation, you certify that you understand the following:

· Depending on specific position requirements, the personal services contract will be written as one of the following:

· Full-time: Typically 260 workdays authorized per contract year (10 workdays per two-week Pay Period (PP)) and 26 PPs per contract year) with a minimum of 80 hours each PP. Most individuals will not qualify as dependents, and when they do, reimbursement of dependent-related expenses and eligibility for Peace Corps-provided assistance to dependents (e.g. securing a visa for the country of assignment) under a full-time contract are very limited.

· Intermittent: When on assignment, the Contractor’s schedule will be full-time (averaging a minimum of 8 hours per workday, with 10 workdays in a PP), with up to 195 work days authorized per contract year (which is subject to change at Peace Corps’ discretion each year). No minimum number of work days authorized per contract year or work days per contract year actually worked are guaranteed. No paid vacation/annual leave or sick leave will be included with an intermittent contract. Any days not worked while under contract will be unpaid. Also, no dependent expenses will be paid for by Peace Corps, nor assistance (e.g. securing a visa for the country of assignment) for dependents will be provided by Peace Corps.

· The RA will be assigned to a post for all working days of their contract. The RA must travel to the post of assignment and will be expected to physically be present in the commuting area of that post of assignment for the length of that assignment. The RA will not be assigned to work at/from the United States. The RA will not be assigned to work at/from the Peace Corps post/facility in their country of citizenship, if one exists.

· Periods of increased work are expected while away from the office on in-country travel and during the periods when working in a delegated Acting capacity or handling the duties of post M&O staff. Further, the RA may be required to hold a duty phone and/or to respond to off-hour calls or attend off-hour meetings (i.e., nights, weekends, and holidays) related to their position. The RA is ineligible for additional pay or leave (e.g., paid leave, holiday pay, or overtime pay) for work performed off-hours (i.e., nights, weekends, and holidays) or for hours spent working beyond their minimum work schedule.

· While traveling, the RA may be lodged at a Peace Corps residence or in another facility with a kitchen and receive a reduced daily per diem allowance during that time.

· This position requires a background investigation to be completed and certification/clearance to be issued prior to the award of a contract (a Top Secret clearance is required for US Citizens) and for the RA to maintain their certification/clearance status throughout the period of the contract and I know of no impediments to my ability to receive and maintain such a certification/clearance.

· This position requires a medical evaluation and doctor’s note or medical clearance for overseas assignments within the EMA or AF Region prior to award of a contract and for the RA to maintain their health status throughout the period of the contract. For US Citizens, a Worldwide Department of State medical clearance is required. I know of no impediments to my ability to receive and maintain such medical evaluation and clearance.

· For US Citizens, this position requires coverage under an international health insurance policy (to be acquired independently by the Contractor) that includes overseas hospitalization coverage and to maintain it throughout the period of the contract I do not know of any impediments that I have for obtaining and maintaining such coverage.

· This position requires registration in the System for Awards Management (SAM) prior to award of a contract and for the RA to maintain an active registration in SAM throughout the period of the contract and I know of no impediments to my ability to receive and maintain such an active registration.

· This position requires the selected RA to begin the personal services contract within six (6) months following the receipt of a tentative offer.

· This position requires funds to be paid electronically in US dollars. I know of no impediments to my ability to open/maintain a bank account where such payment may be deposited.

· This position requires the RA to follow all health and safety guidelines (including COVID-19 protocols such as masking, social distancing, hand hygiene, submitting to temperature checks or other health checks/screenings and/or testing, following quarantine requirements, and following vaccination mandates, etc.) as specified for the position by the Peace Corps.

8. REFERENCES AND RELEASE:

List names, relationship, email addresses, and telephone numbers for three professional references. At least one reference should be an immediate supervisor during the last five years.

A. Name Title/Organization Relationship to applicant Email Phone

B. Name Title/Organization Relationship to applicant Email Phone C. Name Title/Organization Relationship to applicant Email Phone

AUTHORIZATION FOR THE RELEASE OF INFORMATION

By signing the application below and submitting it to Peace Corps in connection with this solicitation, you consent to the following:

I consent to the release of information about me, and release from any liability for their statements all persons, corporations, and other entities who submit information to the Peace Corps to facilitate assessment of my qualifications. This consent includes the release of information that will help Peace Corps evaluate my professional competence, character, ethics, and other qualifications, and to resolve any doubts about my qualifications. I agree that I, as an applicant for affiliation with the Peace Corps, have the burden of producing and for resolving any doubts about such qualifications. If asked by Peace Corps, and I accept an invitation to participate in an interview or other evaluation measure, I consent that this interview and/or other evaluation measure will be utilized to evaluate my professional and other qualifications. I understand that this information will be kept in confidence by the Peace Corps.

8. CERTIFICATION AND SIGNATURE:

I certify that, to the best of my knowledge and belief, all statements made on this form, as well as on all other documents submitted in connection with this application, are true, correct, complete, and made in good faith.

Printed Name:

Signature of Applicant: Date:

2 | Page