Peace Corps Viet Nam ITS Application Form.doc

PEACE CORPS

INFORMATION TECHNOLOGY SPECIALIST (ITS) FOR PEACE CORPS/VIET NAM

PSC APPLICATION FORM

(SOLICITATION #1145PC22R0002)

PEACE CORPS

INFORMATION TECHNOLOGY SPECIALIST (ITS)

PSC APPLICATION FORM

Name

Name

Mailing Address

E-mail Address

Telephone Number

Citizenship(s)

1. List and attach a detailed description of all work experience over the past 10 years, accounting for any periods of unemployment longer than three (3) months. Alternatively, you may attach a signed résumé or Curriculum Vitae (CV) if it contains all the information requested below:

· Work experience for the past 10 years, including your current position,

· Full description of duties and responsibilities for each position, indicating whether position was full or part-time,

· Start and end dates for each position held,

· Salary for each position,

· Number of persons supervised,

· Trainings directed or delivered,

· Reason for leaving,

· Names and telephone numbers of supervisors,

· Volunteer positions,

· Languages spoken and level of fluency,

· Names of certifications held (e.g. A+, Network+, Security+, MCSE, CCNA or similar) and dates certifications were issued,

· Previous experience with Peace Corps or comparable international organization,

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

2. Please describe any post-secondary (e.g. University) education or training in the fields of computer science, information systems management, electronics engineering, or equivalent you have completed to include the name and address of the school where the education or training occurred and the dates attended. If a Degree was conferred (e.g. baccalaureate degree (BS), state the title of the Degree and/or major conferred and the date of Degree conferment.

3. Please complete the two right columns in the following chart.

At least one year of experience with the administration of computer systems with and training/work experience using Windows Servers.

Ability to communicate effectively orally and in writing in English.

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

· This position is a full-time personal services contract position physically reporting to the Peace Corps/Vietnam office in Hanoi, Vietnam.

· This position requires a medical evaluation and clearance.

· This position requires a background investigation and clearance and I know of no impediments to my ability to receive and maintain such a clearance.

· This position requires a medical evaluation and clearance and I know of no impediments to my ability to receive and maintain such medical evaluation and clearance.

· This position requires registration in the System for Awards Management (SAM) and I am willing to be registered and maintain my registration.

· The IT Specialist 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. Outside of emergency situations, the IT Specialist is not eligible for premium pay or compensatory time for work performed outside of regular work hours.

· This position requires the IT Specialist to follow all health and safety guidelines (including COVID-19 protocols such as masking, social distancing, hand hygiene, submitting to temperature 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.

4. 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).

5. In the last 10 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?

No

Yes - please explain below:

6. References 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

C. Name

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.

CERTIFICATION

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.

Signature of Applicant

Date:

Printed Name

Revised February 19, 2019

PAGE