Roving Senior Advisor Application Form.doc

Name

PEACE CORPS

ROVING SENIOR ADVISOR (RSA) PERSONAL SERVICES CONTRACTOR

APPLICATION FORM

Solicitation #: 1145PC23R0016 Name

Mailing Address

E-mail Address

Telephone Number

Citizenship(s)

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

Full-Time RSA Positions:

Yes FORMCHECKBOX

No FORMCHECKBOX

Intermittent RSA Positions:

Yes FORMCHECKBOX

No FORMCHECKBOX

1. 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 RSA Personal Services Contractor advertisement:

· 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 of presentations and/or trainings directed or delivered

· Number/type of written publications authored

· Trainings directed or delivered

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

· Reason for leaving

· Languages spoken

· Ensure any of the following are specifically highlighted within your resume or CV:

· Previous experience with Peace Corps and/or other international volunteer organizations

· Previous experience in or with a Peace Corps country and/or Region

· Articles or other written works authored, public presentations and/or in-person trainings given, etc.

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

2. Based on what you know about the RSA position, please write a paragraph about why you would be the best applicant for this position.

3. This position requires travel 100% of the time on overseas assignments to support a post's country program needs, and therefore requires extreme flexibility and adaptability. 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. 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 requires travel 100% of the time on overseas assignments to support a post's country program needs, and therefore requires extreme flexibility and adaptability. This is neither a remote position nor will telework be permitted beyond that permitted by the applicable Peace Corps policies/procedures regarding PSC telework at the post of assignment. The RSA will be assigned to a post for all working days of their contract. The PSC will not be assigned to work from the United States or at/from the Peace Corps post in a country where they are a citizen or permanent resident, if any.

· This position reports directly to the Associate Director for the Office of Global Operations (AD/OGO) who is based in Peace Corps Headquarters.

· Depending on specific position requirements, certain contracts will be written as one of the following:

· Full-time: Typically 260 work days authorized per contract year, a minimum of 40 hours of work per week. 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: Full-time on an as-needed/intermittent basis (averaging a minimum of 8 hours per work day), 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 RSA 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 RSA 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 will often be lodged at a Peace Corps residence or in another facility with a kitchen and receive a reduced daily meals and incidental expenses allowance during that time.

· This position requires a background investigation and a Top Secret security clearance, and I do not know of any impediments that I have for receiving and maintaining such a clearance.

· This position requires a medical evaluation and Department of State worldwide medical clearance, and I do not know of any impediments that I have for receiving and maintaining such a clearance.

· This position requires registration in the System for Award Management (www.sam.gov) and I do not know of any impediments that I have for completing and maintaining such active registration.

· This position requires coverage under an international health insurance policy (to be acquired independently by the Contractor) that includes overseas hospitalization coverage and I do not know of any impediments that I have for obtaining and maintaining such coverage.

· This position requires payment to be made in US dollars via electronic funds transfer (EFT) and I do not know of any impediments that I have for opening and/or maintaining a bank account that allows receipt of US dollars via EFT.

· This position requires the SRA to follow all health and safety guidelines as specified for the position by the Peace Corps in accordance with public health and/or occupational health or safety policies.

6. 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).

7. 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?

FORMCHECKBOX

No

FORMCHECKBOX

Yes (if yes, please explain below)

8. 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

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