SF-171 - continuation sheet.pdf

Standard Form PDF 78 KB Posted

Attached to
Counternarcotics Technical Advisor
Solicitation number
PSC-26-041-INL
Issued by

About this file

This is a Standard Form 171-A (SF 171-A), which is a continuation sheet used for supplemental work experience documentation in federal employment applications. The form serves as an attachment to the primary SF 171 application and must be affixed at the top of page 3 of the applicant's submission.

The SF 171-A provides multiple blocks for applicants to document additional work experience beyond what can be captured on the main application form. Each block requires the applicant to enter: employer organization name and address with ZIP code, exact job title (including federal series, grade, or rank if applicable), employment dates (month, day, and year), average hours per week, number of employees supervised, immediate supervisor name and telephone number, detailed description of specific duties and responsibilities, salary information (starting and ending amounts), and reasons for leaving or wanting to leave the position. For positions involving multiple types of work, applicants must specify the approximate percentage of time allocated to each task. The form includes a "For Agency Use" section for skill codes and other personnel data. The form is OMB-approved under OMB No. 3206-0012 and was last revised in June 1988, with a usable period through December 31, 1990.

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Who attaches SF 171

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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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