SF-171 - continuation sheet.pdf
Standard Form PDF 78 KB Posted
- Attached to
- Law Enforcement Advisor
- Solicitation number
- PSC-27-006-INL
About this file
Standard Form 171-A is a continuation sheet used for federal employment applications to provide additional work experience history beyond what the primary SF 171 form accommodates. The form allows applicants to document multiple positions with detailed employment information for each role. Key data fields include the applicant's name, Social Security number, the specific job title or announcement number being applied for, and the date the form was completed. For each additional work experience block, applicants must provide the employer's name and address with ZIP code, exact job title, employment dates (month, day, and year), average hours worked per week, number of employees supervised, and starting and ending salary information. The form also requires a detailed description of specific duties, responsibilities, and accomplishments, with percentage breakdowns if multiple types of work were performed during the position.
The form includes sections for identifying the immediate supervisor's name and telephone number, the applicant's reason for leaving each position, and any federal employment classification (series, grade, or rank with promotion dates if applicable). Space is provided for agency use to record skill codes and other relevant information. The form is approved under OMB No. 3206-0012, with the revision date of June 1988, and emphasizes that all SF 171-A continuation sheets should be attached to the top of page three of the main application. The form reflects the U.S. Office of Personnel Management's commitment to equal employment opportunity and includes options to save data, print, email the form, or navigate to additional pages.
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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 .