SF-171 - continuation sheet.pdf
PDF 78 KB Posted
- Attached to
- Program Management and Oversight Advisor
- Solicitation number
- PSC-26-036-INL
About this file
This is Standard Form 171-A, a continuation sheet for federal employment applications (SF 171). The form is used to document additional work experience beyond what can be captured on the primary SF 171 application. Each section on the form allows applicants to record detailed employment history including employer organization name and address, job title, employment dates (month, day, and year), supervisor information with contact details, and average hours worked per week. Applicants must describe specific duties, responsibilities, and accomplishments for each position, specify the percentage of time spent on different work types if applicable, and note the number of employees supervised. The form also captures salary information (starting and ending amounts), federal employment classification details (series, grade, or military rank), promotion dates if applicable, and reasons for leaving or wanting to leave each position. A section marked "For Agency Use (skill codes, etc.)" allows reviewing agencies to note relevant competencies.
The form is designed as a repeating template containing multiple work experience blocks to accommodate extensive employment histories. Applicants must attach all SF 171-A continuation sheets to the top of page 3 of their primary application. The form requires applicants to enter their name (Last, First, Middle Initial), Social Security Number, the job title or announcement number being applied for, and the date the form was completed. The document was revised in June 1988 and remains usable through December 31, 1990, with an OMB approval number of 3206-0012. The form reinforces that the federal government is an equal opportunity employer.
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| File | Type | Posted |
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| SF-171 Fillable.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
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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: |
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| 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 .