SF-171 - continuation sheet.pdf
Standard Form PDF 78 KB Posted
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- INL Program Coordinator
- Solicitation number
- PSC-27-002-INL
About this file
This document is the Standard Form 171-A (SF 171-A), a continuation sheet for the Standard Form 171, which is used for federal employment applications. The form is designed to capture additional work experience that cannot fit on the primary SF 171 application.
The SF 171-A allows applicants to document multiple work positions by providing structured fields for each employment block. Required information includes the employer's name and address with ZIP code, exact job title (with federal series, grade, or rank if applicable), dates of employment by month, day, and year, average hours worked per week, number of employees supervised, starting and ending salary, the immediate supervisor's name and telephone number, and a detailed description of specific duties, responsibilities, and accomplishments. Applicants must also specify their reason for leaving each position and indicate the percentage of time spent on different types of work if multiple job functions were performed. The form includes sections for the applicant's name, Social Security number, the job title or announcement number being applied for, and the date the form was completed. A "For Agency Use" section is provided for skill codes and other administrative purposes. All SF 171-A continuation sheets must be attached to the application at the top of page 3. The form was revised in June 1988 and is approved under OMB No. 3206-0012.
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Text version
Your immediate supervisor N a me Te l eph phone No.
N am e and ad dr ess of employer's organization(include ZIP Code, if known)
Exact title of your job If Federal employment (civilian or military) list series, grade 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.
Dates employed (give month, day and year)
From: To:
Average number of hours per week
Number of employees you supervise
Your reason for wanting to leave
ADDITIONAL WORK EXPERIENCE BLOCKS
For Agency Use (skill codes, etc.)
Salary or earnings
Starting $ per
Ending $ per
Your immediate supervisor N a me Te l eph on e N o .
Name and address of employer's organization (include ZIP Code, if known)
Exact title of your job If Federal employment (civilian or military) list series, grade 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.
Dates employed (give month, day and year)
From: To:
Average number of hours per week
Number of employees you supervise
Your reason for leaving
For Agency Use (skill codes, etc.)
Salary or earnings
Starting $ per
Ending $ per
Attach all SF 171-A's to your application at the top of page 3.
Form Approved:
OMB No. 3206-0012
Standard Form 171-A Continuation Sheet for SF 171
1. Name (Last, First, Middle Initial)
3. Job Title or Announcement Number You Are Applying For
2. Social Security Number
4. Date Completed
THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
PREVIOUS EDITION USABLE UNTIL 12-31-90 NSN 7540-00-935-7157 171-206
Standard F orm 171-A ( Rev. 6-88) U.S. Office of Personnel Management
FPM Chapter 295
Your immediate supervisor N a me Te l eph on e N o .
Name and address of employer's organization (include ZIP Code, if known)
Exact title of your job If Federal employment (civilian or military) list series, grade 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.
Dates employed (give month, day and year)
From: To:
Average number of hours per week
Number of employees you supervise
Your reason for wanting to leave
ADDITIONAL WORK EXPERIENCE BLOCKS
Salary or earnings
Starting $ per
Ending $ per
For Agency Use (skill codes, etc.)
Attach all SF 171-A's to your application at the top of page 3.
Form Approved:
OMB No. 3206-0012
Standard Form 171-A Continuation Sheet for SF 171 (Back)
1. Name (Last, First, Middle Initial)
3. Job Title or Announcement Number You Are Applying For
2. Social Security Number
4. Date Completed
Standard F orm 171-A (BA CK) (Rev. 6-88) U.S . Office of Pe rsonnel M an agement
FPM Chapter 295
| b: |
| EMPLYRNAME1: |
| EMPLYRADDR1: |
| POSFROMDATE1: |
| POSTODATE1: |
| POSHRS1: |
| EMPSUPV1: |
| POSSTARTSALARY1: |
| POSSTARTSALARYPER1: |
| POSENDSALARY1: |
| POSENDSALARYPER1: |
| POSLEAVEREASON1: |
| SPVRNAME1: |
| POSTITLE1: |
| POSGRADE1: |
| POSSERIES1: |
| LASTPROMODATE1: |
| SSN: |
| EMPLYRNAME2: |
| EMPLYRADDR2: |
| POSTODATE2: |
| POSHRS2: |
| EMPSUPV2: |
| POSSTARTSALARY2: |
| POSSTARTSALARYPER2: |
| POSENDSALARY2: |
| POSENDSALARYPER2: |
| POSLEAVEREASON2: |
| SPVRNAME2: |
| POSTITLE2: |
| POSGRADE2: |
| POSSERIES2: |
| EMPLYRNAME3: |
| EMPLYRADDR3: |
| POSFROMDATE3: |
| POSTODATE3: |
| POSHRS3: |
| EMPSUPV3: |
| POSSTARTSALARY3: |
| POSSTARTSALARYPER3: |
| POSENDSALARY3: |
| POSENDSALARYPER3: |
| POSLEAVEREASON3: |
| SPVRNAME3: |
| POSTITLE3: |
| POSGRADE3: |
| POSSERIES3: |
| LASTPROMODATE3: |
| Save Data: |
| Print: |
| Email Form: |
| Retrieve Data: |
| Reset Form: |
| BLOCK3: |
| BLOCK1: |
| Next Page: |
| POSFROMDATE2: |
| BLOCK2: |
| g: |
| POSSKILLCODES1: |
| POSSKILLCODES2: |
| SPVRTELNO1: |
| SPVRTELNO2: |
| LASTNAME: |
| APPPOSTITLE: |
| COMPLETEDDATE: |
| SPVRTELNO3: |
| POSDESCRIP1: |
| POSDESCRIP8: |
| LASTPROMODATE2: |
| FIRSTNAME: |
| MINAME: |
| POSSKILLCODES3: |
| Previous Page: |
| POSDESCRIP2: |
| POSDESCRIP9: |
| POSDESCRIP10: |
| POSDESCRIP11: |
File details come from the government source that posted it. Updated .