SF-171 - continuation sheet.pdf
Standard Form PDF 78 KB Posted
- Attached to
- Maritime Security Advisor
- Solicitation number
- PSC-27-003-INL
About this file
Summary
Standard Form 171-A is a continuation sheet used to supplement the SF 171 (Application for Federal Employment) form. This form allows applicants to provide additional work experience beyond what can be documented on the primary SF 171 application. The form is designed for applicants seeking federal civilian or military positions and must be attached to the top of page 3 of the main application.
The form contains multiple blocks for documenting additional employment history, with each block requesting the employer's name and address (including ZIP code), exact job title, employment dates (month, day, and year), average hours per week, number of employees supervised, salary information (starting and ending amounts), description of work duties and accomplishments, supervisor's name and telephone number, and the applicant's reason for leaving each position. For federal employment, applicants must list the series, grade, or rank, and provide the date of last promotion if applicable. The form includes space for agency use to record skill codes and other administrative information. Approved under OMB No. 3206-0012, this revised version (6-88) was usable until December 31, 1990, and applicants are instructed to attach all SF 171-A continuation sheets when submitting their applications.
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| File | Type | Posted |
|---|---|---|
| SF-171 Fillable.pdf |
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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 .