SF-171 - continuation sheet.pdf
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- Solicitation number
- PSC-26-001-INL
About this file
The document is a Standard Form 171-A Continuation Sheet for SF 171, which is an employment application form used by the U.S. Office of Personnel Management. The form provides space for applicants to detail additional work experience, including employer information, job titles, dates of employment, salary, supervisor details, and a description of specific duties and responsibilities. The form is designed to capture comprehensive employment history for federal job applications, with sections for listing multiple previous jobs, hours worked, number of employees supervised, and reasons for leaving previous positions. It includes fields for agency use and carries an OMB approval number, emphasizing its official federal employment documentation purpose.
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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
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| 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: |
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| 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 .