SF-171 - continuation sheet.pdf

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Attached to
Maritime Law Enforcement Advisor
Solicitation number
PSC-26-027-INL
Issued by

About this file

This document is Standard Form 171-A, a continuation sheet for federal employment applications (SF 171), used by the U.S. Office of Personnel Management. The form provides additional work experience blocks allowing applicants to document multiple employment positions when space on the primary SF 171 is insufficient. Each work experience block requires applicants to provide the employer's name and address, exact job title, employment dates, average hours per week, number of employees supervised, salary information (starting and ending), supervisor contact information, and a detailed description of specific duties, responsibilities, and accomplishments. For federal employment positions, applicants must specify the series, grade or rank, and promotion dates if applicable. The form also requests the applicant's reason for leaving or wanting to leave each position.

The form is designed to be attached to the top of page 3 of the primary SF 171 application and includes fields for applicant identification (name, Social Security number, job title or announcement number being applied for, and date completed). A "For Agency Use" section is included for skill codes and other administrative notations. The form was last revised in June 1988, carries OMB approval number 3206-0012, and notes that the Federal Government is an equal opportunity employer. All SF 171-A continuation sheets must be included with the complete application submission for federal job positions.

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SF-171 Fillable.pdf 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:

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