OF-612 HTML Form

This form is designed as a html table, not a true interactive form. You should be able to save this form and edit it in MS Word or any word processor that accepts html formats. However, you may have to adjust or expand work experience data blocks.

OF-612 Form

U.S. Government Printing Office: 1995 -387-722/20002

1. Job title in Announcement: 2.Grade(s)applying for: 3. Announcement number:
4. Last name: First and middle names: 5. Social Security Number:
6. Mailing address: 7. Phone numbers (include area code): 
Daytime (  )  
Evening (  )
City State Zip Code

WORK EXPERIENCE
8. Describe your paid and nonpaid work experience related to the job for which you are applying. Do not attach job descriptions.
1) Job title (if Federal, include series and grade)
From (MM/YY) To (MM/YY) Salary per
$		 Hours per week
Employer's name and address: Supervisor's name and phone number:
Describe Your Duties & Accomplishments.
2) Job title (if Federal, include series and grade)
From (MM/YY) To (MM/YY) Salary per

$

 Hours per week
Employer's name and address: Supervisor's name and phone number:
Describe Your Duties & Accomplishments
9. May we contact your current supervisor? 
YES (     )    NO  (      )

If we need to contact your current supervisor before making an offer, we will contact you first.

EDUCATION
10. Mark highest level completed: 
Some HS (   )  HS/GED (   )  Associate (   )  Bachelor (   ) Master (   )  Doctoral (   )
11. Last high school (HS) or GED school. Give the school's name, city, state, ZIP code (if known), and year diploma orGED received.
12. Colleges and universities attended. Do not attach a copy of your transcript unless requested.
1. Name Total Credits Earned or Semester Quarter Major(s): Degree - Year (if any) Earned
City State Zip Code
2. Name Total Credits Earned or Semester Quarter Major(s): Degree - Year (if any) Earned
City State Zip Code
3. Name Total Credits Earned per Semester Quarter Major(s): Degree - Year (if any) Earned
City State Zip Code

OTHER QUALIFICATIONS
13. Job-related training courses (give title and year).Job-related skills (other languages, computer software/hardware, tools, machinery, typing speed, etc.). Job-related certificates and licenses (current only). Job-related honors, awards, and special accomplishments (publications,membership in professional/honor societies, leadership activities, public speaking, and performance awards). Give dates, but do not send documents unless requested.

GENERAL
14. Are you a U.S. citizen? YES(_____) NO(_____) --> Give the country of your citizenship.
15. Do you claim veterans' preference? NO (_____) YES (_____)

If yes, mark your claim of 5 or 10 points below: 5 points [___] > Attach your DD 214 or other proof. 10 points [___]. Attach an Application for 10-Point Veterans' Preference (SF-15) and proof required.
16. Were you ever a Federal civilian employee? 
NO (_____)   YES (_____)

If YES goto #17 -->>>>

 17. Are you eligible for reinstatement based on career or career-conditional Federal status? 
NO(_____)   YES (_____)

If requested, attach SF-50 proof.

APPLICANT CERTIFICATION
18. I certify that, to the best of my knowledge and belief, all of the information on and attached to this application is true, correct, complete and made in good faith. I understand that false or fraudulent information on or attached to this application may be grounds for not hiring me or for firing me after I begin work, and may be punishable by fine or imprisonment. I understand that any information I give may be investigated.
  
SIGNATURE                                          DATE SIGNED