+--------+-----------+-------------------------------------------------+
| ![     | **N       | **Executive Personnel Action Document**         |
| ](medi | ational** |                                                 |
| a/imag |           | *(Instructions on page 2)*                      |
| e1.wmf | **Ae      |                                                 |
| ){widt | ronautics |                                                 |
| h="0.8 | and       |                                                 |
| 111111 | Space**   |                                                 |
| 111111 |           |                                                 |
| 111in" | #         |                                                 |
| height | ### Admin |                                                 |
| ="0.76 | istration |                                                 |
| 180555 |           |                                                 |
| 555555 |           |                                                 |
| 55in"} |           |                                                 |
+--------+-----------+-------------------------------------------------+
| **     |           |                                                 |
| ACTION |           |                                                 |
| SUM    |           |                                                 |
| MARY** |           |                                                 |
+--------+-----------+-------------------------------------------------+

+---------------------+------------------------------------------------+
| **NAME:**           | #######                                        |
+---------------------+------------------------------------------------+
| **ACTION            |                                                |
| REQUESTED:**        |                                                |
+---------------------+------------------------------------------------+
| **CURRENT           |                                                |
| POSITION:**         |                                                |
+---------------------+------------------------------------------------+
| **PROPOSED          |                                                |
| POSITION**          |                                                |
|                     |                                                |
| **AND LOCATION:**   |                                                |
+---------------------+------------------------------------------------+
| **SUP               |                                                |
| ERVISORY/MANAGERIAL |                                                |
| EXPERIENCE:**       |                                                |
+---------------------+------------------------------------------------+
| **M                 |                                                |
| ULTI-ORGANIZATIONAL |                                                |
| EXPERIENCE:**       |                                                |
+---------------------+------------------------------------------------+
| **FORMAL EXECUTIVE  |                                                |
| TRAINING:**         |                                                |
+---------------------+------------------------------------------------+

**BACKGROUND/JUSTIFICATION:**

+-----------------------+---------+------------------------------------+
| # NAME:               | # ACT   |                                    |
|                       | ION REQ |                                    |
|                       | UESTED: |                                    |
|                       |         |                                    |
|                       | #       |                                    |
+-----------------------+---------+------------------------------------+
| **REQUESTOR           |         |                                    |
| (SIGNATURE AND        |         |                                    |
| DATE)**               |         |                                    |
+-----------------------+---------+------------------------------------+
| EXECUTIVE POSITION    |         | INSTALLATION HUMAN RESOURCES       |
| MANAGER               |         | DIRECTOR                           |
+-----------------------+---------+------------------------------------+
| # HEAD                |         |                                    |
| QUARTERS CONCURRENCES |         |                                    |
|  (SIGNATURE AND DATE) |         |                                    |
+-----------------------+---------+------------------------------------+
| DIRECTOR OF           |         |                                    |
| MISSION/MISSION       |         |                                    |
| SUPPORT OFFICE (if    |         |                                    |
| applicable)           |         |                                    |
+-----------------------+---------+------------------------------------+
| DIRECTOR, WORKFORCE   |         |                                    |
| MANAGEMENT AND        |         |                                    |
| DEVELOPMENT DIVISION  |         |                                    |
+-----------------------+---------+------------------------------------+
| ASSISTANT             |         |                                    |
| ADMINISTRATOR FOR     |         |                                    |
| HUMAN CAPITAL         |         |                                    |
| MANAGEMENT            |         |                                    |
+-----------------------+---------+------------------------------------+
| ASSOCIATE             |         |                                    |
| ADMINISTRATOR FOR     |         |                                    |
| INSTITUTIONS AND      |         |                                    |
| MANAGEMENT            |         |                                    |
+-----------------------+---------+------------------------------------+
| CHIEF OF STAFF        |         |                                    |
+-----------------------+---------+------------------------------------+
| ASSOCIATE             |         |                                    |
| ADMINISTRATOR         |         |                                    |
+-----------------------+---------+------------------------------------+
| DEPUTY ADMINISTRATOR  |         |                                    |
+-----------------------+---------+------------------------------------+
|                       |         |                                    |
+-----------------------+---------+------------------------------------+

**INSTRUCTIONS:** *This form should be used for all personnel actions
pertaining to Senior Executive Service (SES) and Senior Level (SL)
positions, which require Headquarters approval. This form is used in
lieu of memoranda and other personnel forms such as the SF-52, "Request
for Personnel Action."* *Refer to supplemental standards or criteria for
additional guidance.*

**[ACTION SUMMARY]{.underline}:**

-   **NAME:** Enter name of incumbent or selectee.\*

-   **ACTION REQUESTED:** Enter one of the following: appointment,
    reassignment, pay level adjustment, request new position, or other
    appropriate action AND type of position (e.g. appointment to SES
    position, or establish SL position).

-   **CURRENT POSITION:** Enter title, organization and Center of
    incumbent/selectee's current position.\*

-   **PROPOSED POSITION:** Enter title, organization and Center of
    position to be established or filled. Delete this row for actions
    involving no position change.

-   **SUPERVISORY/MANAGERIAL EXPERENCE:** List key positions held
    (indicate grade level), limiting to a few entries. Describe
    supervisory and management experience in terms of number of
    employees supervised, size of budget, scope of project oversight,
    etc. Note significant accomplishments and high-level recognition.
    Focus is on *progressively responsible* supervisory/management
    experience.\*

-   **MULTI-ORGANIZATIONAL EXPERIENCE:** List jobs and/or details,
    projects, or assignments that reflect
    organizational/functional/geographical mobility. Focus is on
    substantial experience outside of home Center (or HQ).\*

-   **FORMAL EXECUTIVE TRAINING:** List training courses that address
    leadership/executive competencies (e.g., SES ECQ's). Courses must be
    at least 1 week in length, for a total of at least 80 hours, and
    must include multi-agency and/or private sector participation in
    addition to Agency employees. See SES Selection Standards for
    examples.\*

-   **BACKGROUND/JUSTIFICATION:** Begin with *brief* description of
    position. For selections, reassignments (if HQ approval required to
    reassign), and other actions affecting a selection or incumbent,
    provide a succinct, compelling case that the person's background
    shows strong leadership experience and/or potential, how the person
    stands out, and how the person is expected to contribute (or has and
    will continue to contribute) to a particular NASA program, to merit
    selection/promotion. Tie individual's competencies to the position.
    For new positions, justify the need for the position, and explain
    how it fits into the organization and why it should be established
    at the executive level.

\* Delete row if requesting new position, unless HQ approval of
selection/reassignment is required.

**[REQUESTOR]{.underline}:** Heads of Headquarters Offices and Center
Directors have been identified as Executive Position Managers (EPMs) in
NPG 3100.1, "Management of the Senior Executive Service;" are
responsible for initiating executive personnel actions, and must sign
this document. Local human resources offices should be consulted early
in the process; the human resources director must sign this document.
For actions affecting Headquarters positions, this form should be
forwarded through the Mission/Mission Support Directorate (if
appropriate) and Office of Institutional and Corporate Management to the
Agency Human Resources Division for appropriate staffing. For Center
positions, this form should be forwarded through the appropriate
Headquarters Center Executive for concurrence by the Mission Directorate
Associate Administrator, then to the Agency Human Resources Division for
staffing.

**[HEADQUARTERS CONCURRENCES]{.underline}:** Concurrence is required by
the appropriate Mission Director Associate Administrator when the action
originates at a NASA Field Center. Additional concurrence(s) by the HQ
functional office or program office may be required (insert row(s) below
signature block for Mission Directorate Associate Administrator).
Indicate title(s) of concurring official(s).

**[SUPPORTING DOCUMENTATION]{.underline}:** *In addition* to the
information on this form and the documents required in NPG 3317.1, "SES
Career Merit Staffing," the following documents should be included as
attachments to the appropriate action request:

-   **Selection/Pay level adjustment for SES member:** A statement
    signed by the EPM addressing established Evaluation Criteria.

-   **New position:** Organizational chart showing executive level
    positions under the purview of the EPM, with position titles and
    names.