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**u.s. Department of transportation**

**2008 transportation career residency program**

**Application form available at
[www.careers.dot.gov/08CRP](http://www.careers.dot.gov/08CRP)**

**To apply for the 2008 Transportation Career Residency Program, email
your application form, undergraduate and graduate transcripts (if
applicable), and resume to <career.residency@dot.gov>. The application
package in its entirety must be received no later than Friday, April 25,
2008, 5:00 pm ET.**

<table style="width:100%;">
<colgroup>
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 8%" />
<col style="width: 3%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 3%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 4%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="36"><h2 id="applicant-information">Applicant
Information</h2></td>
</tr>
<tr class="even">
<td colspan="2">Last</td>
<td colspan="11">                                   </td>
<td colspan="4">First</td>
<td colspan="9">                         </td>
<td colspan="2">MI</td>
<td colspan="8">               </td>
</tr>
<tr class="odd">
<td colspan="7">Street Address</td>
<td
colspan="18">                                                                 </td>
<td colspan="9">Apartment/Unit #</td>
<td colspan="2">     </td>
</tr>
<tr class="even">
<td colspan="5">City</td>
<td colspan="10">                                   </td>
<td colspan="3">State</td>
<td colspan="7">                    </td>
<td colspan="3">ZIP</td>
<td colspan="8">                   </td>
</tr>
<tr class="odd">
<td colspan="6">Home Phone</td>
<td colspan="10">                                   </td>
<td colspan="4">Cell Phone</td>
<td colspan="16"><blockquote>
<p>                                   </p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="7">Permanent Email</td>
<td
colspan="29">                                                                                               </td>
</tr>
<tr class="odd">
<td colspan="11">Are you a citizen of the United States?</td>
<td colspan="3">YES </td>
<td colspan="4">NO </td>
<td colspan="18">If no, you are not eligible to apply. U.S. Citizenship
required.</td>
</tr>
<tr class="even">
<td colspan="11">Have you ever worked for the Federal Government?</td>
<td colspan="3">YES </td>
<td colspan="4">NO </td>
<td colspan="4">If yes, when?</td>
<td colspan="14">                                   </td>
</tr>
<tr class="odd">
<td colspan="11">Have you ever been convicted of a felony?</td>
<td colspan="3">YES </td>
<td colspan="4">NO </td>
<td colspan="5">If yes, explain.</td>
<td colspan="13">                                   </td>
</tr>
<tr class="even">
<td colspan="36"></td>
</tr>
<tr class="odd">
<td colspan="36"><h2 id="undergraduate-education">UNDERGRAduate
Education</h2></td>
</tr>
<tr class="even">
<td colspan="3">School</td>
<td colspan="33"><blockquote>
<p>                                                                                                    </p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="5">Degree</td>
<td colspan="5">               </td>
<td colspan="2">Major(s)</td>
<td colspan="15">                                             </td>
<td colspan="5">GPA</td>
<td colspan="4">          </td>
</tr>
<tr class="even">
<td colspan="36"><h2 id="graduate-education-if-applicable">Graduate
Education (IF APPLICABLE)</h2></td>
</tr>
<tr class="odd">
<td colspan="3">School</td>
<td colspan="33"><blockquote>
<p>                                                                                                    </p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="5">Degree</td>
<td colspan="5">               </td>
<td colspan="2">Major(s)</td>
<td colspan="15">                                             </td>
<td colspan="5">GPA</td>
<td colspan="4">          </td>
</tr>
<tr class="odd">
<td colspan="36"><h2 id="section"></h2></td>
</tr>
<tr class="even">
<td colspan="36"><h2
id="military-service-you-must-submit-your-military-dd-214-document-as-part-of-the-application-package.">Military
Service <em>You must submit your military DD-214 document as part of the
application package.</em></h2></td>
</tr>
<tr class="odd">
<td colspan="4">Branch</td>
<td
colspan="17">                                                            </td>
<td colspan="3">From</td>
<td colspan="7">               </td>
<td colspan="2">To</td>
<td colspan="3">     </td>
</tr>
<tr class="even">
<td colspan="8">Rank at Discharge</td>
<td
colspan="13">                                                       </td>
<td colspan="8">Type of Discharge</td>
<td colspan="7">               </td>
</tr>
<tr class="odd">
<td colspan="9">If other than honorable, explain.</td>
<td
colspan="27">                                                                                     </td>
</tr>
<tr class="even">
<td colspan="36"></td>
</tr>
<tr class="odd">
<td colspan="36"><h2 id="section-1"></h2></td>
</tr>
<tr class="even">
<td colspan="36"><h2 id="section-2"></h2></td>
</tr>
<tr class="odd">
<td colspan="36"><h2
id="positions-select-the-positions-for-which-you-wish-to-be-considered.-you-may-select-more-than-one-series.">positions
<em>Select the positions for which you wish to be considered. You may
select more than one series.</em> </h2></td>
</tr>
<tr class="even">
<td colspan="21"><p>Most positions are located at DOT headquarters in
Washington, DC.</p>
<p>If selected, are you willing to consider employment outside of
Washington, DC?</p></td>
<td colspan="9">YES </td>
<td colspan="5">NO </td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="17"><p>Transportation Specialist – General (GS-2101) /</p>
<p>Transportation Industry Analyst – General (GS-2110) *</p></td>
<td></td>
<td colspan="17"><p>Transportation Specialist – Aviation (GS-2101) /</p>
<p>Transportation Industry Analyst – Aviation (GS-2110) *</p></td>
</tr>
<tr class="even">
<td></td>
<td colspan="17">Management/Program Analyst (GS-343)</td>
<td></td>
<td colspan="17">Human Resources Specialist (GS-201)</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="17">Engineer (GS-800)</td>
<td></td>
<td colspan="17">Information Technology Specialist (GS-2210)</td>
</tr>
<tr class="even">
<td></td>
<td colspan="17">Contract Specialist (GS-1102)</td>
<td></td>
<td colspan="17">Accountant (GS-500)</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="17">Budget Analyst (GS-500)</td>
<td></td>
<td colspan="17">Financial Analyst (GS-500)</td>
</tr>
</tbody>
</table>

> \* amended 04/11/08

+-----------------------------------------------------------------------+
| ## In the sp                                                          |
| ace provided below and in 500 words or less, describe why you are the |
|  best candidate for the 2008 Transportation career residency program. |
+-----------------------------------------------------------------------+
|                                                                       |
|                                                                       |
|                                                                       |
|                                                                       |
|                                                                       |
|                                                                       |
|                                                                       |
|                                                                       |
|                                                                       |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **THANK YOU FOR YOUR INTEREST IN THE 2008 TRANSPORTATION CAREER       |
| RESIDENCY PROGRAM.**                                                  |
|                                                                       |
| **OPEN PERIOD: Wednesday, February 6, 2008 00:00 ET -- Friday, April  |
| 25, 2008 17:00 ET**                                                   |
|                                                                       |
| DOT will review applications on an ongoing basis and contact          |
| candidates for interviews throughout the open period of the           |
| announcement. Applications will be reviewed on February 21, March 28, |
| April 25 (closing date). Following these dates, we will contact       |
| qualified applicants to schedule interviews. We will give equal       |
| consideration to all applications received.                           |
+-----------------------------------------------------------------------+
| The U.S. Department of Transportation is an Equal Opportunity         |
| Employer. All qualified applicants will be considered regardless of   |
| political affiliation, race, color, religion, national origin,        |
| gender, sexual orientation, marital status, age, disability, or other |
| non-merit factors. If you require reasonable disability-related       |
| accommodations for any part of the application or hiring process,     |
| please notify us at                                                   |
| [career.residency@dot.gov](mailto:career.re                           |
| sidency@dot.gov?subject=Disability Accommodation Request for 08 CRP). |
+-----------------------------------------------------------------------+

**U.S. DEPARTMENT OF TRANSPORTATION**

**APPLICANT BACKGROUND QUESTIONNAIRE**

+------------------------------------+---------------------------------+
| The U.S. Department of             | According to the Paperwork      |
| Transportation requests that you   | Reduction Act of 1995, no       |
| voluntarily complete this form to  | persons are required to respond |
| assist the agency in evaluating    | to a collection of information  |
| and improving its efforts to       | unless it displays a valid OMB  |
| publicize job openings and to      | control number. The valid OMB   |
| encourage employment applications  | control number for this         |
| from a diverse group of qualified  | information is 2105-0557.       |
| candidates. The Department will    |                                 |
| use the data you supply to         | The public reporting burden for |
| determine how many applicants are  | this collection of information  |
| from different groups and how many | is estimated to average 4       |
| of these applicants are qualified  | minutes per response, including |
| for the job in question. The       | the time for reviewing          |
| Department will then assess the    | instructions, searching         |
| effectiveness of specific outreach | existing data sources,          |
| efforts and means of communicating | gathering and maintaining the   |
| information on job vacancies in    | data needed, and completing and |
| light of this information.         | reviewing the collection of     |
| Personal identifying information   | information. Send comments      |
| will not be included in the        | regarding this burden estimate  |
| tabulation of data.                | or any other aspect of this     |
|                                    | collection of information,      |
| The completion of this form is     | including suggestions for       |
| voluntary. This information will   | reducing this burden to the     |
| have no effect on the processing   | U.S. Department of              |
| of your application or hiring      | Transportation, Departmental    |
| decisions.                         | Human Resources Office, 400 7th |
|                                    | St, SW., Washington, DC 20590;  |
| PRIVACY ACT INFORMATION: This      | and the Office of Management    |
| information is provided pursuant   | and Budget, Paperwork Reduction |
| to Public Law 93-579 (Privacy Act  | Project, Washington, D.C.       |
| of 1974), December 31, 1974, for   | 20503.                          |
| individuals completing Federal     |                                 |
| records and forms that solicit     | Solicitation of this            |
| personal information. Authority:   | information is in accordance    |
| Section 7201 of title 5 of the     | with "Federal Equal Opportunity |
| U.S. Code and Section e-16 of      | Recruitment Program" (FEORP),   |
| title 42 of the U.S. Code          | found in part 720 of title 5,   |
|                                    | Code of Federal Regulations.    |
+------------------------------------+---------------------------------+

**PLEASE COMPLETE THE FOLLOWING:**

+---------------------------+------+-------+--------------------------+
| **Na                      |      |       | **Sex:**                 |
| me:                    ** |      |       |                          |
|                           |      |       | [     ]{.underline}Male  |
| **                        |      |       | [                        |
|                        ** |      |       |      ]{.underline}Female |
+---------------------------+------+-------+--------------------------+
| **Title, Grade, and       |      |       |                          |
| Announcement Number of    |      |       |                          |
| position for which you    |      |       |                          |
| are applying:**           |      |       |                          |
|                           |      |       |                          |
| **2008 Transportation     |      |       |                          |
| Career Residency          |      |       |                          |
| Program**                 |      |       |                          |
+---------------------------+------+-------+--------------------------+
| **Do you have a           |      |       |                          |
| disability?**             |      |       |                          |
| [     ]{.underline} Yes   |      |       |                          |
| [     ]{.underline} No    |      |       |                          |
+---------------------------+------+-------+--------------------------+
| **If yes, please provide  |      |       |                          |
| information on your       |      |       |                          |
| disability by selecting   |      |       |                          |
| the appropriate           |      |       |                          |
| category:**               |      |       |                          |
|                           |      |       |                          |
| [     ]{.underline} I do  |      |       |                          |
| not chose to identify my  |      |       |                          |
| disability                |      |       |                          |
| [     ]{.underline}       |      |       |                          |
| Complete paralysis        |      |       |                          |
|                           |      |       |                          |
| [     ]{.underline} Total |      |       |                          |
| Deafness                  |      |       |                          |
| [     ]{.underline}       |      |       |                          |
| Convulsive disorder       |      |       |                          |
|                           |      |       |                          |
| [     ]{.underline}       |      |       |                          |
| Blind/uncorrectable       |      |       |                          |
| visual impairment         |      |       |                          |
| [     ]{.underline}       |      |       |                          |
| Mental retardation        |      |       |                          |
|                           |      |       |                          |
| [     ]{.underline}       |      |       |                          |
| Missing extremity(ies)    |      |       |                          |
| [     ]{.underline}       |      |       |                          |
| Mental or emotional       |      |       |                          |
| illness                   |      |       |                          |
|                           |      |       |                          |
| [     ]{.underline}       |      |       |                          |
| Partial paralysis         |      |       |                          |
| [     ]{.underline}       |      |       |                          |
| Severe distortion of      |      |       |                          |
| limbs or spine            |      |       |                          |
|                           |      |       |                          |
| [     ]{.underline} I     |      |       |                          |
| have a disability but it  |      |       |                          |
| is not listed             |      |       |                          |
+---------------------------+------+-------+--------------------------+
| **Are you of Hispanic or  |      |       |                          |
| Latino origin?**          |      |       |                          |
| [     ]{.underline} Yes   |      |       |                          |
| [     ]{.underline} No    |      |       |                          |
+---------------------------+------+-------+--------------------------+
| **Please select one or    |      |       |                          |
| more racial categories:** |      |       |                          |
+---------------------------+------+-------+--------------------------+
| [     ]{.underline}       | A    |       |                          |
| American Indian or Alaska | pe   |       |                          |
| Native                    | rson |       |                          |
|                           | ha   |       |                          |
|                           | ving |       |                          |
|                           | ori  |       |                          |
|                           | gins |       |                          |
|                           | in   |       |                          |
|                           | any  |       |                          |
|                           | of   |       |                          |
|                           | the  |       |                          |
|                           | orig |       |                          |
|                           | inal |       |                          |
|                           | peo  |       |                          |
|                           | ples |       |                          |
|                           | of   |       |                          |
|                           | N    |       |                          |
|                           | orth |       |                          |
|                           | and  |       |                          |
|                           | S    |       |                          |
|                           | outh |       |                          |
|                           | Ame  |       |                          |
|                           | rica |       |                          |
|                           | (i   |       |                          |
|                           | nclu |       |                          |
|                           | ding |       |                          |
|                           | Cen  |       |                          |
|                           | tral |       |                          |
|                           | A    |       |                          |
|                           | meri |       |                          |
|                           | ca), |       |                          |
|                           | and  |       |                          |
|                           | who  |       |                          |
|                           | m    |       |                          |
|                           | aint |       |                          |
|                           | ains |       |                          |
|                           | cult |       |                          |
|                           | ural |       |                          |
|                           | id   |       |                          |
|                           | enti |       |                          |
|                           | fica |       |                          |
|                           | tion |       |                          |
|                           | thr  |       |                          |
|                           | ough |       |                          |
|                           | tr   |       |                          |
|                           | ibal |       |                          |
|                           | aff  |       |                          |
|                           | ilia |       |                          |
|                           | tion |       |                          |
|                           | or   |       |                          |
|                           | c    |       |                          |
|                           | ommu |       |                          |
|                           | nity |       |                          |
|                           | att  |       |                          |
|                           | achm |       |                          |
|                           | ent. |       |                          |
+---------------------------+------+-------+--------------------------+
| [     ]{.underline} Asian | A    |       |                          |
|                           | pe   |       |                          |
|                           | rson |       |                          |
|                           | ha   |       |                          |
|                           | ving |       |                          |
|                           | ori  |       |                          |
|                           | gins |       |                          |
|                           | in   |       |                          |
|                           | any  |       |                          |
|                           | of   |       |                          |
|                           | the  |       |                          |
|                           | orig |       |                          |
|                           | inal |       |                          |
|                           | peo  |       |                          |
|                           | ples |       |                          |
|                           | of   |       |                          |
|                           | the  |       |                          |
|                           | Far  |       |                          |
|                           | E    |       |                          |
|                           | ast, |       |                          |
|                           | S    |       |                          |
|                           | outh |       |                          |
|                           | east |       |                          |
|                           | A    |       |                          |
|                           | sia, |       |                          |
|                           | or   |       |                          |
|                           | the  |       |                          |
|                           | In   |       |                          |
|                           | dian |       |                          |
|                           | subc |       |                          |
|                           | onti |       |                          |
|                           | nent |       |                          |
|                           | in   |       |                          |
|                           | clud |       |                          |
|                           | ing, |       |                          |
|                           | for  |       |                          |
|                           | exam |       |                          |
|                           | ple, |       |                          |
|                           | C    |       |                          |
|                           | ambo |       |                          |
|                           | dia, |       |                          |
|                           | Ch   |       |                          |
|                           | ina, |       |                          |
|                           | In   |       |                          |
|                           | dia, |       |                          |
|                           | Ja   |       |                          |
|                           | pan, |       |                          |
|                           | Ko   |       |                          |
|                           | rea, |       |                          |
|                           | M    |       |                          |
|                           | alay |       |                          |
|                           | sia, |       |                          |
|                           | P    |       |                          |
|                           | akis |       |                          |
|                           | tan, |       |                          |
|                           | Ph   |       |                          |
|                           | ilip |       |                          |
|                           | pine |       |                          |
|                           | Isla |       |                          |
|                           | nds, |       |                          |
|                           | T    |       |                          |
|                           | hail |       |                          |
|                           | and, |       |                          |
|                           | and  |       |                          |
|                           | Viet |       |                          |
|                           | nam. |       |                          |
+---------------------------+------+-------+--------------------------+
| [     ]{.underline} Black | A    |       |                          |
| or African American       | pe   |       |                          |
|                           | rson |       |                          |
|                           | ha   |       |                          |
|                           | ving |       |                          |
|                           | ori  |       |                          |
|                           | gins |       |                          |
|                           | in   |       |                          |
|                           | any  |       |                          |
|                           | of   |       |                          |
|                           | the  |       |                          |
|                           | b    |       |                          |
|                           | lack |       |                          |
|                           | ra   |       |                          |
|                           | cial |       |                          |
|                           | gr   |       |                          |
|                           | oups |       |                          |
|                           | of   |       |                          |
|                           | Afr  |       |                          |
|                           | ica. |       |                          |
+---------------------------+------+-------+--------------------------+
| [     ]{.underline}Native | A    |       |                          |
| Hawaiian or other Pacific | pe   |       |                          |
| Islander                  | rson |       |                          |
|                           | ha   |       |                          |
|                           | ving |       |                          |
|                           | ori  |       |                          |
|                           | gins |       |                          |
|                           | in   |       |                          |
|                           | any  |       |                          |
|                           | of   |       |                          |
|                           | the  |       |                          |
|                           | orig |       |                          |
|                           | inal |       |                          |
|                           | peo  |       |                          |
|                           | ples |       |                          |
|                           | of   |       |                          |
|                           | Haw  |       |                          |
|                           | aii, |       |                          |
|                           | G    |       |                          |
|                           | uam, |       |                          |
|                           | Sa   |       |                          |
|                           | moa, |       |                          |
|                           | or   |       |                          |
|                           | o    |       |                          |
|                           | ther |       |                          |
|                           | Pac  |       |                          |
|                           | ific |       |                          |
|                           | Isla |       |                          |
|                           | nds. |       |                          |
+---------------------------+------+-------+--------------------------+
| [     ]{.underline} White | A    |       |                          |
|                           | pe   |       |                          |
|                           | rson |       |                          |
|                           | ha   |       |                          |
|                           | ving |       |                          |
|                           | ori  |       |                          |
|                           | gins |       |                          |
|                           | in   |       |                          |
|                           | any  |       |                          |
|                           | of   |       |                          |
|                           | the  |       |                          |
|                           | orig |       |                          |
|                           | inal |       |                          |
|                           | peo  |       |                          |
|                           | ples |       |                          |
|                           | of   |       |                          |
|                           | Eur  |       |                          |
|                           | ope, |       |                          |
|                           | the  |       |                          |
|                           | Mi   |       |                          |
|                           | ddle |       |                          |
|                           | E    |       |                          |
|                           | ast, |       |                          |
|                           | or   |       |                          |
|                           | N    |       |                          |
|                           | orth |       |                          |
|                           | Afr  |       |                          |
|                           | ica. |       |                          |
+---------------------------+------+-------+--------------------------+
| **How did you find out    |      |       |                          |
| about this vacancy?       |      |       |                          |
| (Select all that apply)** |      |       |                          |
+---------------------------+------+-------+--------------------------+
| [     ]{.underline} 1.    |      | [     |                          |
| Magazine/Newspaper        |      |   ]{. |                          |
|                           |      | under |                          |
| [     ]{.underline} 2.    |      | line} |                          |
| Radio/Television          |      | 8.    |                          |
| Broadcast                 |      | F     |                          |
|                           |      | riend |                          |
| [     ]{.underline} 3.    |      | or    |                          |
| DOT Human Resources       |      | Rel   |                          |
| Office                    |      | ative |                          |
|                           |      | Wo    |                          |
| [     ]{.underline} 4.    |      | rking |                          |
| State Employment Office   |      | for   |                          |
|                           |      | DOT   |                          |
| [     ]{.underline} 5.    |      |       |                          |
| Government Recruitment at |      | [     |                          |
| School                    |      |   ]{. |                          |
|                           |      | under |                          |
| [     ]{.underline} 6.    |      | line} |                          |
| Attendance at Conference, |      | 9.    |                          |
| Meeting, or Job Fair      |      | F     |                          |
|                           |      | riend |                          |
| Specify:                  |      | or    |                          |
|                           |      | Rel   |                          |
|                           |      | ative |                          |
| [     ]{.underline} 7.    |      | Not   |                          |
| Federal, State, or Local  |      | Wo    |                          |
| Job Information Center    |      | rking |                          |
|                           |      | for   |                          |
|                           |      | DOT   |                          |
|                           |      |       |                          |
|                           |      | [     |                          |
|                           |      |   ]{. |                          |
|                           |      | under |                          |
|                           |      | line} |                          |
|                           |      | 10.   |                          |
|                           |      | DOT's |                          |
|                           |      | C     |                          |
|                           |      | areer |                          |
|                           |      | in    |                          |
|                           |      | M     |                          |
|                           |      | otion |                          |
|                           |      | Web   |                          |
|                           |      | Site  |                          |
|                           |      |       |                          |
|                           |      | www.  |                          |
|                           |      | caree |                          |
|                           |      | rs.do |                          |
|                           |      | t.gov |                          |
|                           |      |       |                          |
|                           |      | [     |                          |
|                           |      |   ]{. |                          |
|                           |      | under |                          |
|                           |      | line} |                          |
|                           |      | 11.   |                          |
|                           |      | Int   |                          |
|                           |      | ernet |                          |
|                           |      | or    |                          |
|                           |      | Other |                          |
|                           |      | Web   |                          |
|                           |      | Site  |                          |
|                           |      |       |                          |
|                           |      | [     |                          |
|                           |      |   ]{. |                          |
|                           |      | under |                          |
|                           |      | line} |                          |
|                           |      | 12.   |                          |
|                           |      | State |                          |
|                           |      | Vocat |                          |
|                           |      | ional |                          |
|                           |      | Reha  |                          |
|                           |      | bilit |                          |
|                           |      | ation |                          |
|                           |      | A     |                          |
|                           |      | gency |                          |
|                           |      | or    |                          |
|                           |      |       |                          |
|                           |      | U.S.  |                          |
|                           |      | Dept. |                          |
|                           |      | of    |                          |
|                           |      | Vete  |                          |
|                           |      | ran's |                          |
|                           |      | Af    |                          |
|                           |      | fairs |                          |
|                           |      |       |                          |
|                           |      | [     |                          |
|                           |      |   ]{. |                          |
|                           |      | under |                          |
|                           |      | line} |                          |
|                           |      | 13.   |                          |
|                           |      | O     |                          |
|                           |      | ther. |                          |
|                           |      |       |                          |
|                           |      | Spe   |                          |
|                           |      | cify: |                          |
|                           |      |       |                          |
|                           |      |       |                          |
|                           |      |       |                          |
|                           |      |       |                          |
|                           |      |       |                          |
+---------------------------+------+-------+--------------------------+