SF-171 - continuation sheet.pdf

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Attached to
Senior Police Advisor
Solicitation number
PSC-26-034-INL
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About this file

This document is Standard Form 171-A, a continuation sheet for Standard Form 171 (Application for Federal Employment). The form is used by applicants to provide additional work experience information beyond what can be accommodated on the primary SF 171 application.

The SF 171-A contains multiple identical work experience blocks designed to capture detailed employment history. Each block requests the applicant's immediate supervisor's name and telephone number, employer organization name and address with ZIP code, exact job title, and federal employment classification if applicable (including series, grade, or rank and promotion date). Applicants must describe specific duties, responsibilities, and accomplishments, including any supervisory positions and the percentage of time spent on each type of work if multiple duties are performed. Additional required information includes employment dates (month, day, and year), average hours worked per week, number of employees supervised, and reason for leaving. The form also captures salary information (starting and ending amounts) and includes a section for agency use regarding skill codes. All SF 171-A continuation sheets must be attached to the application at the top of page 3. The form is approved under OMB No. 3206-0012, was last revised June 1988, and states that the Federal Government is an equal opportunity employer.

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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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