+-------------------+---------------------------+----------------------+
| ![](              | **BPA VACANCY             | ##                   |
| media/image1.wmf) | ANNOUNCEMENT**            |                      |
|                   |                           | ## U.S.              |
|                   | **(#003238-05-MP)**       | DEPARTMENT OF ENERGY |
|                   |                           |                      |
|                   |                           | BONNEVILLE POWER     |
|                   |                           | ADMINISTRATION       |
|                   |                           |                      |
|                   |                           | #########            |
+-------------------+---------------------------+----------------------+

+--------------------+------------------------+------------------------+
| ##### PO           |                        |                        |
| SITION(s): ELECTRI |                        |                        |
| CAL APPRENTICES -  |                        |                        |
|                    |                        |                        |
| ##### Power Sy     |                        |                        |
| stem Electrician A |                        |                        |
| pprentice, BB-2810 |                        |                        |
|                    |                        |                        |
| ###### Lineman A   |                        |                        |
| pprentice, BB-2810 |                        |                        |
|                    |                        |                        |
| ###### Sub         |                        |                        |
| station Operator A |                        |                        |
| pprentice, BB-5407 |                        |                        |
|                    |                        |                        |
| ##### LOCATION(s): |                        |                        |
|                    |                        |                        |
| **Washington,      |                        |                        |
| Oregon, Montana,   |                        |                        |
| Idaho ([More than  |                        |                        |
| one selection will |                        |                        |
| be                 |                        |                        |
| ma                 |                        |                        |
| de]{.underline})** |                        |                        |
|                    |                        |                        |
| #####              |                        |                        |
+--------------------+------------------------+------------------------+
| ##### OPENING DATE | **CLOSING DATE**       | **HOURLY PAY RATE(s)** |
+--------------------+------------------------+------------------------+
| ##### 10/03/05     | **11/14/05**           | **\$21.49**            |
+--------------------+------------------------+------------------------+

**[WHO MAY APPLY:]{.underline}** Career and Career Conditional Employees
of Bonneville Power Administration, Transfer Eligibles, Reinstatement
Eligibles, 30% or more Disabled Veterans, Veterans eligible to apply
under VRA, Veterans eligible to apply under the Veterans Employment Act
of 1998, and CTAP/ITCAP Eligibles.

**[WHAT WILL I BE DOING:]{.underline}** Electrical apprentices are
trained to perform a variety of tasks and duties associated with the
operation, maintenance, and construction of high voltage electrical
power system equipment and facilities. Apprentices receive on-the job
training by working with journeyman of the trade in learning the various
tasks, work procedures, and skills of the trade. In addition,
apprentices receive classroom instruction in electrical theory, print
and schematic drawings, and other topics associated with the particular
trade. Apprentices receive progressively more difficult and complex
tasks and work assignments as they gain skill and knowledge in the trade
and are required to successfully demonstrate their skill level and
knowledge at the end of each step of the program. Apprentices are
required to work safely and follow safety procedures and guidelines.

**[Power System Electrician Apprentices]{.underline}** are trained to
perform a variety of tasks that typically involve the construction,
installation, maintenance, and repair of high voltage power system
electrical equipment. Maintenance tasks typically include the routine
inspection, modification, installation, and troubleshooting of
electrical equipment and facilities. The type of equipment maintained
may be electrical, hydraulic, mechanical, pneumatic, and/or electronic.
Apprentices work from sketches, drawings, blueprints, wiring diagrams,
instruction books, and equipment manuals.

**[Lineman Apprentices]{.underline}** are trained to maintain and
construct high voltage wood pole and steel structure transmission lines.
Apprentices receive training that includes, but is not limited to:
climbing techniques and procedures; care and inspection of transmission
structure hardware, tools, gear, and a variety of equipment (e.g.,
vehicles, bucket trucks, etc.); digging procedures; guying of pole
structures; right-of-way maintenance procedures; rigging and handling of
conductor; conductor splicing; steel tower erection, and other work
techniques.

**[Substation Operator Apprentices]{.underline}** are trained to operate
high voltage power system equipment to remove and return substation
equipment to service. Work tasks may include, but are not limited to:
the review of station logs; checking equipment automatic logging
devices, event recorders, and other devices for proper operation.
Apprentices also read and analyze substation drawings, plan and perform
switching procedures, tag equipment, and coordinate with power system
dispatchers. In addition, apprentices read meters, instruments, gauges,
and other equipment and maintain records; inspect switchyards and
out-building for proper security.

**[NOTES/CONDITIONS OF EMPLOYMENT:]{.underline}**

-   In addition to the wage rate, BPA pays a supplement equal to 4.4% of
    the wage rate to permanent employees for each hour of straight-time
    wages that are paid.

```{=html}
<!-- -->
```
-   This agency provides reasonable accommodations to applicants with
    disabilities. If you need a reasonable accommodation for any part of
    the application and hiring process, please notify the agency. The
    decision on granting reasonable accommodation will be on a
    case-by-case basis.

```{=html}
<!-- -->
```
-   Candidates considered to be best qualified may be further evaluated
    by an interview with the Apprentice Craft Committee for the
    applicable craft(s).

-   Selected employees will be required to pass a pre-employment
    physical examination and drug test at BPA's expense.

```{=html}
<!-- -->
```
-   In accordance with Department of Energy Order 3792.3, this position
    is subject to random drug testing. Failure to pass subsequent tests
    may result in disciplinary action, including removal from the
    Federal service.

```{=html}
<!-- -->
```
-   Upon successful completion of the apprentice program, management
    will determine duty station placement.

-   Apprentices [will be required]{.underline} to travel during their
    training program to gain experience.

**[APPRENTICE EXAMINATION INFORMATION (Please note changes from prior
testing procedures):]{.underline}**

The apprenticeship examination is a [requirement]{.underline} for all
applicants that pass the initial screening. **[If you do not take this
examination, you will be eliminated from further consideration for the
position]{.underline}.** The examination will cover the following areas:
high school level algebra and geometry; dexterity; arithmetic
computations; ability to follow instructions and mechanical aptitude.
The examination process will take approximately 4 hours. **If you have
applied for more than one apprentice craft, you only need to take the
examination one time (applicants will have only one opportunity to
test). You will receive a notice by mail if your complete application
has been received and it has been determined that you are eligible to
test. This notice will list all testing dates, locations and times.
Appointments will not be scheduled for testing; all eligible applicants
may show up at the location and time of their choice and will be tested
on a first-come, first-served basis, with a limit of 50 people per test
session. You will be required to bring your eligibility notice with you
to the test. (Applicants who travel to take the Apprentice Exam do so at
their own expense).**

Apprentice exams are scheduled for **December 3 and 10, 2005 in
Vancouver, Washington, and December 10, 2005 in Spokane, Washington.**

**[Special Conditions of Employment]{.underline}**:

Apprentices are required to meet some or all of the following
conditions:

-   Participate in all training activities. Satisfactory completion of
    each step of training is mandatory for advancement.

-   Positions that require unescorted access to a nuclear facility will
    be required to take annual radiation training.

-   If exposed to health hazards, have periodic physical examinations.

-   Follow BPA safety practices.

-   Live within one-hour travel time of duty location.

-   Obtain and maintain a Restricted Electrical Workers' permit.

-   Obtain, possess and maintain a valid commercial driver's license.

-   Obtain and maintain certification on equipment assigned to use or
    operate.

-   Take First Aid training and possess and maintain a CPR card.

-   Be available for call to work at any time.

-   Be able to wear protective apparel.

-   Apply restricted use pesticides if required.

-   Satisfactorily complete the Standard Clearance Certification
    Examination.

-   Be able to relocate as business needs dictate.

**[APPLICATION AND PROCESS TENTATIVE TIMELINE]{.underline}**:

1.  October -- Announcement Opens

2.  November -- Announcement Closes

3.  December -- Apprentice written exams

4.  Jan/Feb-- Craft Specific Application Rating

5.  March -- Apprentice Interviews

6.  April -- Selections

7.  June -- Hire Date (June 11, 2006)

**[AM I QUALIFIED?]{.underline}**

**[*SELECTIVE PLACEMENT FACTOR*:]{.underline}** These positions have a
selective factor that will serve as a screen-out element. Applicants who
do not show evidence of meeting this selective factor will be rated as
not qualified.

> ***Applicants must submit a copy of their complete employment driving
> record (obtained from the Dept. of Motor Vehicles or equivalent State
> agency) covering the past 3 years and dated within the last 3 months),
> along with their application.*** Candidates with a poor driving
> record\* and/or revocation of license will be immediately disqualified
> from consideration.
>
> **[\*Disqualifying driving records]{.underline}**: **Within the past
> three years**, any of the following conditions disqualify an applicant
> for a U.S. Government Motor Vehicle Authorization: A. Conviction for
> operating a motor vehicle under the influence of alcohol or a
> controlled substance. B. Conviction for leaving the scene of an
> accident without making his or her identity known. C. Suspended,
> revoked, or cancelled driver's license. D. Any recurrent record of
> auto accidents/incidents, traffic violations, or arrests, which
> demonstrate that the driver does not have an adequate sense of
> responsibility. This may be show by any of the following: Conviction
> for fleeing or attempting to elude a police officer; conviction for a
> felony involving the use of a motor vehicle; 2 or more accidents in
> which the driver was at fault; 2 or more excessive speeding violations
> (15 miles per hour or more over the posted speed limit.); or 4 or more
> moving violations.

# HOW WILL MY APPLICATION BE EVALUATED AND REFERRED?

You will be evaluated on the basis of experience, education, and
training as they relate to the elements listed below. You must complete
the attached **Supplemental Questionnaire for Electrical
Apprenticeships** that addresses the following elements: 1) Willingness
and ability to perform the duties of Electrical Apprentice and
Journeyman under various working conditions; 2) Ability to follow
instructions; 3) Dexterity and Safety; 4) Ability to use prints and
drawings; and 5) Ability to use and maintain tools. Experience/training
shown in your supplemental questionnaire must be reflected in your
application

-   All applicants will be required to pass a written aptitude
    examination prepared by the Office of Personnel Management to be
    considered for a position. All applicants **will be notified** of
    their eligibility (or non-eligibility) to test, and of the dates,
    times and locations of testing.

-   Applicants will be evaluated on the basis of the information
    contained in their application, written test results, and the
    attached Supplemental Questionnaire for Electrical Apprenticeships.

-   Candidates considered to be best qualified on the above-mentioned
    job elements may be further evaluated by an interview with the
    Apprentice Craft Committee for the applicable craft(s).

**[WORKING CONDITIONS:]{.underline}** Working conditions vary depending
on the specific apprentice craft and tasks assigned. Some or all of the
following conditions may apply: Work may be performed outside in all
weather conditions during the day or night. System priorities may
require extended periods of overtime, including working weekends. Work
may be performed around energized equipment, and at various heights that
may be in excess of 100 feet, such as on steel framework, platforms, and
ladders adjacent to energized high-voltage equipment. At times, work may
be physically demanding, and the work environment will occasionally
include high noise levels or exposure to hazardous substances such as
mercury, acids, radiation, solvents, PCB's, etc. Electrical apprentices
can expect to be in a travel status a substantial amount of time (varies
depending on craft) since assignments away from the headquarters will be
required (may be up to 6 months in duration) to complete some work
processes.

**[PHYSICAL REQUIREMENTS]{.underline}:** Incumbents must be physically
and mentally able to efficiently perform the duties of the position,
with or without reasonable accommodation, without hazard to themselves
or others. Depending on the craft and tasks assigned, work may require
some or all of the following: Extensive bending, pushing, pulling,
reaching, and climbing; occasional crawling; and working in cramped
confined positions. Walking long distances over rugged terrain. The
ability to grip and hold lines and ropes with 75 to 90 pounds of weight
attached and the ability to work with small components. Working around
machinery with moving parts. Strenuous tasks that include loading or
unloading crates or other equipment weighing up to 75 pounds. The
ability to work at heights that may be in excess of 535 feet. The
ability to perform work under varying terrain and climatic conditions.
Good distance vision in at least one eye and the ability to read printed
material the size of typewritten characters. The ability to distinguish
different electrical components based on color coding. The ability to
hear the conversational voice. The ability to clearly communicate.
Extensive day and night driving. The ability to move and position loads
weighing up to 120 pounds. The ability to wear protective apparel that
includes respirators. Working with both arms overhead. Working alone
under stressful situations requiring exacting procedures and the
pressure of emergencies.

**[HOW TO APPLY]{.underline}:**

BPA's [Application Package
Checklist](http://www.jobs.bpa.gov/Application Package Checklist.doc)
and [Frequently Asked Questions](http://www.jobs.bpa.gov/faq.htm)
[(FAQ's)]{.underline} will assist you in preparing and ensuring your
application package is complete. The checklist is for your personal use
only (please do not submit it with your application).

You can access BPA's Apprentice Website for more information about the
Apprentice Program. The link is: [Apprentice
Program](http://www.transmission.bpa.gov/EdCar/Apprenticeships/default.cfm?page=AP).

**Submit your application with the supplemental information listed
below**:

-   Submit your resume, [Optional Application for Federal Employment
    (OF-612)](http://www.opm.gov/forms/html/of.asp), or other written
    application format of your choice that fully describes your
    education and experience.

-   If eligibility to apply is based on military service (VEOA, VRA, 30%
    or more disabled veteran), you must submit Member 4 copy of Military
    Discharge Papers, DD-214 **(REQUIRED);** and (if applicable): Letter
    of compensable disability dated within the last 12 months).

-   Completed Supplemental Questionnaire for Electrical Apprenticeships
    is **[REQUIRED]{.underline}**. Be sure that you indicate which
    apprenticeship position(s) you are applying for on the 1^st^ page of
    the supplemental. An electronically fillable form can be downloaded
    from the following location
    [www.jobs.bpa.gov/How_To_Apply/Electrical Apprentice Supplemental
    Questionnaire.doc](http://www.jobs.bpa.gov/How_To_Apply/Electrical Apprentice Supplemental Questionnaire.doc)

-   DOE F 1600.7e, Applicant Disability, Race/National Origin and Sex
    Identification form (attached or may be accessed at:
    <http://www.directives.doe.gov/pdfs/forms/1600-7.pdf>

-   [OF-306](http://www.opm.gov/forms/pdf_fill/of0306.pdf) (revised
    1/01), Declaration for Federal Employment (**attached**).

-   Employment Driving record abstract for past three (3) years
    (obtained from the Dept. of Motor Vehicles or equivalent State
    agency, dated within the last 3 months). **(REQUIRED**)

-   Copy of Notification of Personnel Action (SF-50). **REQUIRED** if
    you are a current or former Federal employee.

**[INFORMATION WE REQUIRE IN ORDER TO PROCESS YOUR
APPLICATION\*:]{.underline}**

1.  Announcement number, title, and grade of the position for which you
    are applying. **PLEASE CHECK WHICH APPRENTICE POSITION(S) YOU ARE
    APPLYING FOR (ON THE FIRST PAGE OF THE ATTACHED SUPPLEMENTAL
    QUESTIONNAIRE FOR APPRENTICESHIP POSITIONS).**

2.  Your full name, mailing address, day and evening telephone number,
    and e-mail address (if applicable).

3.  Your Social Security Number.

4.  Country of citizenship.

5.  Work experience (Paid and non-paid experience related to the job for
    which you are applying. Include job title (PLEASE INCLUDE SERIES AND
    GRADE IF FEDERAL JOB), duties and accomplishments, employer\'s name
    and address, supervisor\'s name and phone number, starting and
    ending dates (including month and year), salary, hours worked per
    week, salary).

6.  Indicate if we may contact your current supervisor.

7.  A list of other job related training, skills (for example,
    languages, tools, machinery, typing speed, etc.), certificates and
    licenses, honor societies, awards, professional membership,
    publications, leadership activities, performance awards, etc.

8.  2 --3 references that can verify the work experience information
    provided in your application or resume. Please include names,
    titles, and current contact information. (BPA requires reference
    checks prior to appointment).

**\* All application materials MUST be submitted by the closing date of
the announcement - we will not contact you for missing information and
will assess your application based only on information received by the
closing date. Please retain a copy of your application as BPA does not
return applications or provide copies.**

# DOES BPA PROVIDE REASONABLE ACCOMMODATIONS FOR APPLICANTS WITH A DISABILITY?

Yes. If you need a reasonable accommodation for any part of the
application and hiring process, please contact BPA's Human Resources
Specialist, PJ Johns at 503-230-3000. Decisions for granting reasonable
accommodation will be on a case-by-case basis. For more information on
Federal employment for the disabled, please visit
[DisabilityInfo.gov](http://disabilityinfo.gov/).

# WHERE DO I SEND MY APPLICATION?

Your complete application must be received no later than 12 midnight
Pacific Standard (PST) of the closing date to be accepted. Applications
submitted by fax or e-mail must be time/date stamped or electronically
postmarked at point of origin no later than 12 midnight. Applicants will
be notified of receipt of their application package

> **Mail:**

Bonneville Power Administration, ATTN: Employment & Benefits --
CHR/CSB-2, PO Box 491, Vancouver, WA 98666

> Personal Delivery:
>
> Vancouver, WA: 2401 NE Minnehaha Street, Vancouver, WA 98663
>
> Portland, OR: 905 NE 11^th^ Avenue, Portland, OR 97232
>
> **Fax:** Fax your application to (360) 418-2063. Applicants are
> responsible for ensuring that application materials transmit
> successfully. Please include a request for confirmation and the manner
> in which you would like to be contacted on the fax cover sheet if you
> desire confirmation.
>
> **Email:**
>
> Send your application as email attachments to <jobs@bpa.gov>. The
> announcement number must be included in the subject line of the email.
> Applicants who apply by email will receive an email confirmation.

Required forms may be sent as email attachments, may be faxed, or sent
as hard copy. Application materials provided by different means must be
cross--referenced so they may be combined after they arrive. Applicants
are responsible for ensuring that application materials are formatted in
a manner that will transmit successfully.

**[INFORMATION FOR DISPLACED FEDERAL EMPLOYEES:]{.underline}** Displaced
or surplus employees who may be entitled to consideration under
CTAP/ICTAP must meet the OPM and BPA requirements for consideration and
be considered "well-qualified. In order to receive consideration,
displaced/surplus employees must apply for consideration. For additional
information, please refer to [[CAREER TRANSITION ASSISTANCE PROGRAM
(CTAP)/AND INTERAGENCY CAREER TRANSITION ASSISTANCE PROGRAM
(ICTAP)](http://www.usajobs.opm.gov/EI32.htm).]{.underline}

If you have questions, or need a hard copy of information in this
vacancy announcement, please call the Employment Center at any of the
following numbers:

  --------------------------- ----------------- -------------------------
  **Toll Free**               **Vancouver, WA** **Portland, OR**

  1-877-282-3713              360-418-2090      503-230-3055
  --------------------------- ----------------- -------------------------

#### 

#### Website addresses

  --------------------------- ---------------------------------------------------------------------------------------------------------------------
  Application Package         [www.jobs.bpa.gov/Application%20Package%20Checklist.doc](http://www.jobs.bpa.gov/Application Package Checklist.doc)
  Checklist                   

  Optional Application Form   [www.opm.gov/forms/pdf_fill/of0612.pdf](http://www.opm.gov/forms/pdf_fill/of0612.pdf)
  (OF-612)                    

  Optional Form 306           [www.opm.gov/forms/pdf_fill/of0306.pdf](http://www.opm.gov/forms/pdf_fill/of0306.pdf)

  Supplemental                [www.jobs.bpa.gov/How_To_Apply/Electrical Apprentice Supplemental
  Questionnaire-Electrical    Questionnaire.doc](http://www.jobs.bpa.gov/How_To_Apply/Electrical Apprentice Supplemental Questionnaire.doc)
  Apprentice                  

  BPA Benefits                [www.jobs.bpa.gov/benefits](http://www.jobs.bpa.gov/)

  Disability Information      [www.DisabilityInfo.gov](http://disabilityinfo.gov/)

  Frequently Asked Questions  [www.jobs.bpa.gov/faq.htm](http://www.jobs.bpa.gov.faq.htm/)
  --------------------------- ---------------------------------------------------------------------------------------------------------------------

> The Bonneville Power Administration is a harassment free workplace.
>
> Bonneville Power Administration selections are based on merit and are
> accomplished without regard to political, religious, or union
> affiliation or non-affiliation, marital status, race, color, national
> origin, sex, sexual orientation, age, or non--disqualifying physical
> disability. Selections will not be based upon personal relationships,
> patronage, or nepotism.

# EOE 

<table style="width:100%;">
<colgroup>
<col style="width: 0%" />
<col style="width: 19%" />
<col style="width: 13%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 8%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 12%" />
<col style="width: 0%" />
<col style="width: 8%" />
<col style="width: 5%" />
<col style="width: 19%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td colspan="11"><strong>OPTIONAL APPLICATION FOR FEDERAL EMPLOYMENT -
OF 612</strong></td>
<td><p>FORM APPROVED</p>
<p>OMB No. 3206-0219</p>
<p><em>Electronic Form Approved by CGIR</em></p>
<p><em>03/31/98 (VB)</em></p></td>
</tr>
<tr class="even">
<td></td>
<td colspan="12">You may apply for most jobs with a resume, this form,
or other written format. If your resume or application <strong>does not
provide</strong> all the information requested on this form and in the
job vacancy announcement, you may lose consideration for a job.</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="6"><strong>1.</strong> Job title in announcement</td>
<td colspan="3"><strong>2.</strong> Grade(s) applying for</td>
<td colspan="3"><strong>3.</strong> <strong>Announcement</strong>
number</td>
</tr>
<tr class="even">
<td></td>
<td colspan="6"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3"><strong>4.</strong> Last name</td>
<td colspan="6">First and middle names</td>
<td colspan="3"><strong>5.</strong> <strong>Social Security</strong>
Number</td>
</tr>
<tr class="even">
<td></td>
<td colspan="3"><strong>     </strong></td>
<td colspan="6"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="9"><strong>6.</strong> Mailing address</td>
<td colspan="3"><strong>7.</strong> <strong>Phone numbers</strong>
(include area code)</td>
</tr>
<tr class="even">
<td></td>
<td colspan="9"><strong>     </strong></td>
<td><strong>Daytime</strong></td>
<td colspan="2"><strong>     </strong></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4">City</td>
<td>State</td>
<td colspan="4">ZIP Code</td>
<td><strong>Evening</strong></td>
<td colspan="2"><strong>     </strong></td>
</tr>
<tr class="even">
<td></td>
<td colspan="4"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="12"><p>WORK EXPERIENCE</p>
<p><strong>8.</strong> Describe your paid and nonpaid work experience
related to the job for which you are applying. Do <strong>not</strong>
attach job <strong>descriptions.</strong></p></td>
</tr>
<tr class="even">
<td></td>
<td colspan="12"><strong>A)</strong> Job title ( if Federal, include
series and grade)</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="12"><strong>     </strong></td>
</tr>
<tr class="even">
<td></td>
<td>From (MM/YY)</td>
<td>To (MM/YY)</td>
<td colspan="5">Salary</td>
<td>per</td>
<td colspan="4"><strong>Hours per week</strong></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="5"><strong>$      </strong></td>
<td><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
</tr>
<tr class="even">
<td></td>
<td colspan="8">Employer’s name and address</td>
<td colspan="4"><strong>Supervisor’s</strong> name and phone number</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="8"><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
</tr>
<tr class="even">
<td></td>
<td colspan="12">Describe your duties and accomplishments</td>
</tr>
</tbody>
</table>

  -----------------------------------------------------------------------
  **     **

  -----------------------------------------------------------------------

  ----------------- ----------- ----------------- ----------- -----------------------
  **B)** Job title                                            
  (if Federal,                                                
  include series                                              
  and grade)                                                  

  **     **                                                   

  From (MM/YY)      To (MM/YY)  Salary            per         **Hours per week**

  **     **         **     **   **\$****     **   **     **   **     **

  Employer's name                                             **Supervisor's** name
  and address                                                 and phone number

  **     **                                                   **     **

  Describe your                                               
  duties and                                                  
  accomplishments                                             
  ----------------- ----------- ----------------- ----------- -----------------------

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<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 1%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="2">Page 2</td>
<td colspan="28"><strong>OPTIONAL APPLICATION FOR FEDERAL EMPLOYMENT -
0F 612</strong></td>
<td colspan="5"><em>Electronic approved by CGIR - 03/31/98
(VB)</em></td>
<td></td>
</tr>
<tr class="even">
<td colspan="35"><strong>9.</strong> May we contact your current
supervisor?</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="35"><strong>YES</strong> () <strong>NO</strong> () If we
need to contact your current supervisor before making an offer, we will
contact you first.</td>
<td></td>
</tr>
<tr class="even">
<td colspan="35"><strong>EDUCATION</strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="35"><strong>10.</strong> Mark highest level completed. Some
HS () HS/GED () Associate () Bachelor () Master () Doctoral ()</td>
<td></td>
</tr>
<tr class="even">
<td colspan="35"><strong>11.</strong> Last high school (HS) or GED
school. Give the school’s name, city, State, ZIP Code (if known), and
year diploma or GED received.</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="35"><strong>     </strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="35"><strong>12.</strong> Colleges and universities
attended. Do <strong>not</strong> attach a copy of your transcript
unless requested.</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="17"><strong>A)</strong> Name</td>
<td colspan="8">Total Credits Earned</td>
<td colspan="4">Major(s)</td>
<td colspan="3">Degree</td>
<td colspan="4">Year Received</td>
</tr>
<tr class="even">
<td colspan="17" rowspan="2"><strong>     </strong></td>
<td colspan="4">Semester</td>
<td colspan="4">Quarter</td>
<td colspan="4"></td>
<td colspan="7">(if any)</td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="9">City</td>
<td colspan="3">State</td>
<td colspan="5">ZIP Code</td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="9"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td colspan="5"><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="17" rowspan="2"><p><strong>B</strong><strong>)</strong>
Name</p>
<p><strong>     </strong></p></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="9">City</td>
<td colspan="3">State</td>
<td colspan="5">ZIP Code</td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="9"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td colspan="5"><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="17" rowspan="2"><p><strong>C)</strong> Name</p>
<p><strong>     </strong></p></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="9">City</td>
<td colspan="3">State</td>
<td colspan="5">ZIP Code</td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="9"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td colspan="5"><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="35"><em><strong>OTHER QUALIFICATIONS</strong></em></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="35"><strong>13.</strong> <strong>Job-related</strong>
training courses (give title and year). <strong>Job-related</strong>
skills (other languages, computer software/hardware, tools, machinery,
typing speed, etc.). <strong>Job-related</strong> certificates and
licenses (current only). <strong>Job-related</strong> honors, awards,
and special accomplishments (publications, memberships in
professional/honor societies, leadership activities, public speaking,
and performance awards). Give dates, but do <strong>not</strong> send
documents unless requested.</td>
<td></td>
</tr>
<tr class="even">
<td colspan="35"><strong>     </strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="35"><strong>GENERAL</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="10"><strong>1</strong><strong>4.</strong> Are you a U.S.
citizen?</td>
<td colspan="3"><strong>YES</strong></td>
<td colspan="2">()</td>
<td colspan="3"><strong>NO</strong></td>
<td colspan="2">()</td>
<td colspan="3"></td>
<td colspan="5">Give the country of your citizenship.</td>
<td colspan="7"><strong>     </strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="10"><strong>15.</strong> Do you claim veterans’
preference?</td>
<td colspan="3"><strong>NO</strong></td>
<td colspan="2">()</td>
<td colspan="3"><strong>YES</strong></td>
<td colspan="2">()</td>
<td colspan="3"></td>
<td colspan="12">Mark your claim of 5 or 10 points below.</td>
<td></td>
</tr>
<tr class="even">
<td><strong>5 points</strong></td>
<td colspan="3">()</td>
<td colspan="2"></td>
<td colspan="10">Attach your DD 214 or other proof.</td>
<td colspan="3">10 points</td>
<td colspan="3">()</td>
<td colspan="2"></td>
<td colspan="11">Attach an Application for 10-Point Veterans’ Preference
(SF15) and proof required.</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="23"><strong>16.</strong> Were you ever a Federal civilian
employee?</td>
<td colspan="3">Series</td>
<td>Grade</td>
<td colspan="4">From (MM/YY)</td>
<td colspan="3">To (MM/YY)</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="2"><strong>NO</strong></td>
<td colspan="2">()</td>
<td><strong>YES</strong></td>
<td colspan="3">()</td>
<td colspan="2"></td>
<td colspan="10">For highest civilian grade give:</td>
<td colspan="3"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="35"><strong>17.</strong> Are you eligible for reinstatement
based on career or career-conditional Federal status?</td>
<td></td>
</tr>
<tr class="even">
<td colspan="5"><strong>NO</strong></td>
<td colspan="2">()</td>
<td><strong>YES</strong></td>
<td colspan="4">()</td>
<td colspan="2"></td>
<td colspan="21">If requested, attach SF 50 proof.</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="35"><em><strong>APPLICANT CERTIFICATION</strong></em></td>
<td></td>
</tr>
<tr class="even">
<td colspan="35"><strong>18. I certify</strong> 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. <strong>I
understand</strong> 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.
<strong>I understand</strong> that any information I give may be
investigated.</td>
<td></td>
</tr>
</tbody>
</table>

  --------------------------------------------- -------------------------
  **SIGNATURE**                                 **DATE SIGNED**

  **     **                                     **     **
  --------------------------------------------- -------------------------

+-----------------------------------------------------------------------+
| *GENERAL INFORMATION*                                                 |
+-----------------------------------------------------------------------+
| -   You may apply for most Federal jobs with a resume, the attached   |
|     *Optional Application for Federal Employment* or other written    |
|     format. If your resume or application does not provide all the    |
|     information requested on this form and in the job vacancy         |
|     announcement, you may lose consideration for a job. Type or print |
|     clearly in dark ink. Help speed the selection process by keeping  |
|     your application brief and sending only the requested             |
|     information. If essential to attach additional pages, include     |
|     your name and Social Security Number on each page.                |
+-----------------------------------------------------------------------+
| -   For information on Federal employment, including job lists,       |
|     alternative formats for persons with disabilities, and veterans'  |
|     preference, call the U.S. Office of Personnel Management at       |
|     **912-757-3000, TDD 912-744-2299**, by computer modem             |
|     **912-757-3100**, or via the Internet (Telnet only) at            |
|     FJOB.MAIL.OPM.GOV.                                                |
+-----------------------------------------------------------------------+
| -   If you served on active duty in the United States Military and    |
|     were separated under honorable conditions, you may be eligible    |
|     for veterans' preference. To receive preference if your service   |
|     began after October 15, 1976, you must have a Campaign Badge,     |
|     Expeditionary Medal, or service-connected disability. Veterans'   |
|     preference is not a factor for Senior Executive Service jobs or   |
|     when competition is limited to status candidates (current or      |
|     former career or career-conditional Federal employees).           |
+-----------------------------------------------------------------------+
| -   Most Federal jobs require United States citizenship and also that |
|     males over age 18 born after December 31, 1959, have registered   |
|     with the Selective Service System or have an exemption.           |
+-----------------------------------------------------------------------+
| -   The law prohibits public officials from appointing, promoting, or |
|     recommending their relatives.                                     |
+-----------------------------------------------------------------------+
| -   Federal annuitants (military and civilian) may have their         |
|     salaries or annuities reduced. All employees must pay any valid   |
|     delinquent debts or the agency may garnish their salary.          |
+-----------------------------------------------------------------------+
| -   Send your application to the office announcing the vacancy. If    |
|     you have questions, contact that office.                          |
+-----------------------------------------------------------------------+
| **THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER**           |
+-----------------------------------------------------------------------+
| ***PRIVACY ACT AND PUBLIC BURDEN STATEMENTS***                        |
+-----------------------------------------------------------------------+
| -   The Office of Personnel Management and other Federal agencies     |
|     rate applicants for Federal jobs under the authority of sections  |
|     1104, 1302, 3301, 3304, 3320, 3361, 3393, and 3394 of title 5 of  |
|     the United States Code. We need the information requested in this |
|     form and in the associated vacancy announcements to evaluate your |
|     qualifications. Other laws require us to ask about citizenship,   |
|     military service, etc.                                            |
+-----------------------------------------------------------------------+
| -   We request your Social Security Number (SSN) under the authority  |
|     of Executive Order 9397 in order to keep your records straight,   |
|     other people may have the same name. As allowed by law or         |
|     Presidential directive, we use your SSN to seek information about |
|     you from employers, schools, banks, and others who know you. Your |
|     SSN may also be used in studies and computer matching with other  |
|     Government files, for example, files on unpaid student loans.     |
+-----------------------------------------------------------------------+
| -   If you do not give us your SSN or any other information           |
|     requested, we cannot process your application, which is the first |
|     step in getting a job. Also, incomplete addresses and ZIP Codes   |
|     will slow processing.                                             |
+-----------------------------------------------------------------------+
| -   We may give information from your records to: training            |
|     facilities; organizations deciding claims for retirement,         |
|     insurance, unemployment or health benefits; officials in          |
|     litigation or administrative proceedings where the Government is  |
|     a party; law enforcement agencies concerning violations of law or |
|     regulations; Federal agencies for statistical reports and         |
|     studies; officials of labor organizations recognized by law in    |
|     connection with representing employees; Federal agencies or other |
|     sources requesting information for Federal agencies or other      |
|     sources requesting information for Federal agencies in connection |
|     with hiring or retaining, security clearances, security or        |
|     suitability investigations, classifying jobs, contracting, or     |
|     issuing licenses, grants, or other benefits; public and private   |
|     organizations including news media that grant or publicize        |
|     employee recognition and awards; and the Merit System Protection  |
|     Board, the Office of Special Counsel, the Equal Employment        |
|     Opportunity Commission, the Federal Labor Relations Authority,    |
|     the National Archives, the Federal Acquisition Institute, and     |
|     congressional offices in connection with their official           |
|     functions.                                                        |
+-----------------------------------------------------------------------+
| -   We may also give information from your records to: prospective    |
|     nonfederal employers concerning tenure of employment, civil       |
|     service status, length of service, and date and nature of action  |
|     for separation as shown on personnel action forms of specifically |
|     identified individuals; requesting organizations or individuals   |
|     concerning the home address and other relevant information on     |
|     those who might have contracted an illness or been exposed to a   |
|     health hazard; authorized Federal and nonfederal agencies for use |
|     in computer matching; spouses or dependent children asking        |
|     whether the employee has changed from self-and-family to          |
|     self-only health benefits enrollment; individuals working on a    |
|     contract, service, grant, cooperative agreement or job for the    |
|     Federal Government; non-agency members of an agency's performance |
|     or other panel; and agency-appointed representatives of employees |
|     concerning information issued to the employee about               |
|     fitness-for-duty or agency-filed disability retirement            |
|     procedures.                                                       |
+-----------------------------------------------------------------------+
| -   We estimate the public reporting burden for this collection will  |
|     vary form 20 to 240 minutes with an average of 40 minutes per     |
|     response, including time for reviewing instructions, searching    |
|     existing data sources, gathering data, and completing and         |
|     receiving the information. You may send comments regarding the    |
|     burden estimate or any other aspect of the collection of          |
|     information, including suggestions for reducing this burden, to   |
|     U.S. Office of Personnel Management, Reports and Forms Management |
|     Officer, Washington, DC 20415-0001.                               |
+-----------------------------------------------------------------------+
| -   Send your application to the agency announcing the vacancy.       |
+-----------------------------------------------------------------------+

+---+------+-----------------------+------------------+--------------+---+
| # |      | **U.S. DEPARTMENT OF  |                  | *Electronic  |   |
|   |      | ENERGY**              |                  | Form         |   |
| D |      |                       |                  | Approved*    |   |
| O |      |                       |                  |              |   |
| E |      |                       |                  | *By CIL      |   |
|   |      |                       |                  | 07/14/1999*  |   |
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+---+------+-----------------------+------------------+--------------+---+
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+---+------+-----------------------+------------------+--------------+---+
|   | ##   |                       |                  |              |   |
|   |  OMB |                       |                  |              |   |
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|   | den  |                       |                  |              |   |
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|   | losu |                       |                  |              |   |
|   | re S |                       |                  |              |   |
|   | tate |                       |                  |              |   |
|   | ment |                       |                  |              |   |
+---+------+-----------------------+------------------+--------------+---+
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|   | tion |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | inf  |                       |                  |              |   |
|   | orma |                       |                  |              |   |
|   | tion |                       |                  |              |   |
|   | is   |                       |                  |              |   |
|   | e    |                       |                  |              |   |
|   | stim |                       |                  |              |   |
|   | ated |                       |                  |              |   |
|   | to   |                       |                  |              |   |
|   | ave  |                       |                  |              |   |
|   | rage |                       |                  |              |   |
|   | 10   |                       |                  |              |   |
|   | min  |                       |                  |              |   |
|   | utes |                       |                  |              |   |
|   | per  |                       |                  |              |   |
|   | r    |                       |                  |              |   |
|   | espo |                       |                  |              |   |
|   | nse, |                       |                  |              |   |
|   | i    |                       |                  |              |   |
|   | nclu |                       |                  |              |   |
|   | ding |                       |                  |              |   |
|   | the  |                       |                  |              |   |
|   | time |                       |                  |              |   |
|   | for  |                       |                  |              |   |
|   | r    |                       |                  |              |   |
|   | evie |                       |                  |              |   |
|   | wing |                       |                  |              |   |
|   | i    |                       |                  |              |   |
|   | nstr |                       |                  |              |   |
|   | ucti |                       |                  |              |   |
|   | ons, |                       |                  |              |   |
|   | s    |                       |                  |              |   |
|   | earc |                       |                  |              |   |
|   | hing |                       |                  |              |   |
|   | exis |                       |                  |              |   |
|   | ting |                       |                  |              |   |
|   | data |                       |                  |              |   |
|   | sour |                       |                  |              |   |
|   | ces, |                       |                  |              |   |
|   | g    |                       |                  |              |   |
|   | athe |                       |                  |              |   |
|   | ring |                       |                  |              |   |
|   | and  |                       |                  |              |   |
|   | mai  |                       |                  |              |   |
|   | ntai |                       |                  |              |   |
|   | ning |                       |                  |              |   |
|   | the  |                       |                  |              |   |
|   | data |                       |                  |              |   |
|   | nee  |                       |                  |              |   |
|   | ded, |                       |                  |              |   |
|   | and  |                       |                  |              |   |
|   | co   |                       |                  |              |   |
|   | mple |                       |                  |              |   |
|   | ting |                       |                  |              |   |
|   | and  |                       |                  |              |   |
|   | r    |                       |                  |              |   |
|   | evie |                       |                  |              |   |
|   | wing |                       |                  |              |   |
|   | the  |                       |                  |              |   |
|   | co   |                       |                  |              |   |
|   | llec |                       |                  |              |   |
|   | tion |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | info |                       |                  |              |   |
|   | rmat |                       |                  |              |   |
|   | ion. |                       |                  |              |   |
|   | Send |                       |                  |              |   |
|   | comm |                       |                  |              |   |
|   | ents |                       |                  |              |   |
|   | r    |                       |                  |              |   |
|   | egar |                       |                  |              |   |
|   | ding |                       |                  |              |   |
|   | this |                       |                  |              |   |
|   | bu   |                       |                  |              |   |
|   | rden |                       |                  |              |   |
|   | esti |                       |                  |              |   |
|   | mate |                       |                  |              |   |
|   | or   |                       |                  |              |   |
|   | any  |                       |                  |              |   |
|   | o    |                       |                  |              |   |
|   | ther |                       |                  |              |   |
|   | as   |                       |                  |              |   |
|   | pect |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | this |                       |                  |              |   |
|   | co   |                       |                  |              |   |
|   | llec |                       |                  |              |   |
|   | tion |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | info |                       |                  |              |   |
|   | rmat |                       |                  |              |   |
|   | ion, |                       |                  |              |   |
|   | i    |                       |                  |              |   |
|   | nclu |                       |                  |              |   |
|   | ding |                       |                  |              |   |
|   | sug  |                       |                  |              |   |
|   | gest |                       |                  |              |   |
|   | ions |                       |                  |              |   |
|   | for  |                       |                  |              |   |
|   | redu |                       |                  |              |   |
|   | cing |                       |                  |              |   |
|   | this |                       |                  |              |   |
|   | bur  |                       |                  |              |   |
|   | den, |                       |                  |              |   |
|   | to   |                       |                  |              |   |
|   | Of   |                       |                  |              |   |
|   | fice |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | Inf  |                       |                  |              |   |
|   | orma |                       |                  |              |   |
|   | tion |                       |                  |              |   |
|   | R    |                       |                  |              |   |
|   | esou |                       |                  |              |   |
|   | rces |                       |                  |              |   |
|   | Ma   |                       |                  |              |   |
|   | nage |                       |                  |              |   |
|   | ment |                       |                  |              |   |
|   | Pol  |                       |                  |              |   |
|   | icy, |                       |                  |              |   |
|   | Pl   |                       |                  |              |   |
|   | ans, |                       |                  |              |   |
|   | and  |                       |                  |              |   |
|   | Ov   |                       |                  |              |   |
|   | ersi |                       |                  |              |   |
|   | ght, |                       |                  |              |   |
|   | Rec  |                       |                  |              |   |
|   | ords |                       |                  |              |   |
|   | Ma   |                       |                  |              |   |
|   | nage |                       |                  |              |   |
|   | ment |                       |                  |              |   |
|   | D    |                       |                  |              |   |
|   | ivis |                       |                  |              |   |
|   | ion, |                       |                  |              |   |
|   | HR-  |                       |                  |              |   |
|   | 422- |                       |                  |              |   |
|   | GTN, |                       |                  |              |   |
|   | P    |                       |                  |              |   |
|   | aper |                       |                  |              |   |
|   | work |                       |                  |              |   |
|   | R    |                       |                  |              |   |
|   | educ |                       |                  |              |   |
|   | tion |                       |                  |              |   |
|   | Pro  |                       |                  |              |   |
|   | ject |                       |                  |              |   |
|   | (191 |                       |                  |              |   |
|   | 0-06 |                       |                  |              |   |
|   | 00), |                       |                  |              |   |
|   | U.S. |                       |                  |              |   |
|   | De   |                       |                  |              |   |
|   | part |                       |                  |              |   |
|   | ment |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | Ene  |                       |                  |              |   |
|   | rgy, |                       |                  |              |   |
|   | 1000 |                       |                  |              |   |
|   | Inde |                       |                  |              |   |
|   | pend |                       |                  |              |   |
|   | ence |                       |                  |              |   |
|   | Ave  |                       |                  |              |   |
|   | nue, |                       |                  |              |   |
|   | S    |                       |                  |              |   |
|   | .W., |                       |                  |              |   |
|   | Was  |                       |                  |              |   |
|   | hing |                       |                  |              |   |
|   | ton, |                       |                  |              |   |
|   | DC   |                       |                  |              |   |
|   | 20   |                       |                  |              |   |
|   | 585; |                       |                  |              |   |
|   | and  |                       |                  |              |   |
|   | to   |                       |                  |              |   |
|   | the  |                       |                  |              |   |
|   | Of   |                       |                  |              |   |
|   | fice |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | Ma   |                       |                  |              |   |
|   | nage |                       |                  |              |   |
|   | ment |                       |                  |              |   |
|   | and  |                       |                  |              |   |
|   | Bu   |                       |                  |              |   |
|   | dget |                       |                  |              |   |
|   | (O   |                       |                  |              |   |
|   | MB), |                       |                  |              |   |
|   | P    |                       |                  |              |   |
|   | aper |                       |                  |              |   |
|   | work |                       |                  |              |   |
|   | R    |                       |                  |              |   |
|   | educ |                       |                  |              |   |
|   | tion |                       |                  |              |   |
|   | Pro  |                       |                  |              |   |
|   | ject |                       |                  |              |   |
|   | (191 |                       |                  |              |   |
|   | 0-06 |                       |                  |              |   |
|   | 00), |                       |                  |              |   |
|   | Was  |                       |                  |              |   |
|   | hing |                       |                  |              |   |
|   | ton, |                       |                  |              |   |
|   | DC   |                       |                  |              |   |
|   | 20   |                       |                  |              |   |
|   | 503. |                       |                  |              |   |
+---+------+-----------------------+------------------+--------------+---+
|   | ## P |                       |                  |              |   |
|   | RIVA |                       |                  |              |   |
|   | CY A |                       |                  |              |   |
|   | CT S |                       |                  |              |   |
|   | TATE |                       |                  |              |   |
|   | MENT |                       |                  |              |   |
+---+------+-----------------------+------------------+--------------+---+
|   | This |                       |                  |              |   |
|   | data |                       |                  |              |   |
|   | is   |                       |                  |              |   |
|   | b    |                       |                  |              |   |
|   | eing |                       |                  |              |   |
|   | c    |                       |                  |              |   |
|   | olle |                       |                  |              |   |
|   | cted |                       |                  |              |   |
|   | to   |                       |                  |              |   |
|   | plan |                       |                  |              |   |
|   | and  |                       |                  |              |   |
|   | eval |                       |                  |              |   |
|   | uate |                       |                  |              |   |
|   | the  |                       |                  |              |   |
|   | agen |                       |                  |              |   |
|   | cy's |                       |                  |              |   |
|   | rec  |                       |                  |              |   |
|   | ruit |                       |                  |              |   |
|   | ment |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | per  |                       |                  |              |   |
|   | sons |                       |                  |              |   |
|   | with |                       |                  |              |   |
|   | d    |                       |                  |              |   |
|   | isab |                       |                  |              |   |
|   | ilit |                       |                  |              |   |
|   | ies, |                       |                  |              |   |
|   | mi   |                       |                  |              |   |
|   | nori |                       |                  |              |   |
|   | ties |                       |                  |              |   |
|   | and  |                       |                  |              |   |
|   | wo   |                       |                  |              |   |
|   | men, |                       |                  |              |   |
|   | and  |                       |                  |              |   |
|   | to   |                       |                  |              |   |
|   | help |                       |                  |              |   |
|   | en   |                       |                  |              |   |
|   | sure |                       |                  |              |   |
|   | that |                       |                  |              |   |
|   | ag   |                       |                  |              |   |
|   | ency |                       |                  |              |   |
|   | p    |                       |                  |              |   |
|   | erso |                       |                  |              |   |
|   | nnel |                       |                  |              |   |
|   | p    |                       |                  |              |   |
|   | ract |                       |                  |              |   |
|   | ices |                       |                  |              |   |
|   | meet |                       |                  |              |   |
|   | the  |                       |                  |              |   |
|   | requ |                       |                  |              |   |
|   | irem |                       |                  |              |   |
|   | ents |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | Fed  |                       |                  |              |   |
|   | eral |                       |                  |              |   |
|   | law  |                       |                  |              |   |
|   | and  |                       |                  |              |   |
|   | reg  |                       |                  |              |   |
|   | ulat |                       |                  |              |   |
|   | ion. |                       |                  |              |   |
|   | The  |                       |                  |              |   |
|   | data |                       |                  |              |   |
|   | you  |                       |                  |              |   |
|   | su   |                       |                  |              |   |
|   | pply |                       |                  |              |   |
|   | will |                       |                  |              |   |
|   | be   |                       |                  |              |   |
|   | used |                       |                  |              |   |
|   | for  |                       |                  |              |   |
|   | sta  |                       |                  |              |   |
|   | tist |                       |                  |              |   |
|   | ical |                       |                  |              |   |
|   | anal |                       |                  |              |   |
|   | ysis |                       |                  |              |   |
|   | o    |                       |                  |              |   |
|   | nly. |                       |                  |              |   |
|   | SU   |                       |                  |              |   |
|   | BMIS |                       |                  |              |   |
|   | SION |                       |                  |              |   |
|   | OF   |                       |                  |              |   |
|   | THIS |                       |                  |              |   |
|   | INF  |                       |                  |              |   |
|   | ORMA |                       |                  |              |   |
|   | TION |                       |                  |              |   |
|   | IS   |                       |                  |              |   |
|   | VO   |                       |                  |              |   |
|   | LUNT |                       |                  |              |   |
|   | ARY. |                       |                  |              |   |
|   | Fai  |                       |                  |              |   |
|   | lure |                       |                  |              |   |
|   | to   |                       |                  |              |   |
|   | pro  |                       |                  |              |   |
|   | vide |                       |                  |              |   |
|   | this |                       |                  |              |   |
|   | inf  |                       |                  |              |   |
|   | orma |                       |                  |              |   |
|   | tion |                       |                  |              |   |
|   | will |                       |                  |              |   |
|   | have |                       |                  |              |   |
|   | no   |                       |                  |              |   |
|   | ef   |                       |                  |              |   |
|   | fect |                       |                  |              |   |
|   | on   |                       |                  |              |   |
|   | the  |                       |                  |              |   |
|   | pr   |                       |                  |              |   |
|   | oces |                       |                  |              |   |
|   | sing |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | your |                       |                  |              |   |
|   | app  |                       |                  |              |   |
|   | lica |                       |                  |              |   |
|   | tion |                       |                  |              |   |
|   | for  |                       |                  |              |   |
|   | Fed  |                       |                  |              |   |
|   | eral |                       |                  |              |   |
|   | emp  |                       |                  |              |   |
|   | loym |                       |                  |              |   |
|   | ent. |                       |                  |              |   |
|   | In   |                       |                  |              |   |
|   | divi |                       |                  |              |   |
|   | dual |                       |                  |              |   |
|   | p    |                       |                  |              |   |
|   | erso |                       |                  |              |   |
|   | nnel |                       |                  |              |   |
|   | se   |                       |                  |              |   |
|   | lect |                       |                  |              |   |
|   | ions |                       |                  |              |   |
|   | are  |                       |                  |              |   |
|   | not  |                       |                  |              |   |
|   | made |                       |                  |              |   |
|   | b    |                       |                  |              |   |
|   | ased |                       |                  |              |   |
|   | on   |                       |                  |              |   |
|   | this |                       |                  |              |   |
|   | info |                       |                  |              |   |
|   | rmat |                       |                  |              |   |
|   | ion. |                       |                  |              |   |
|   |      |                       |                  |              |   |
|   | Au   |                       |                  |              |   |
|   | thor |                       |                  |              |   |
|   | ity: |                       |                  |              |   |
|   | Sect |                       |                  |              |   |
|   | ions |                       |                  |              |   |
|   | 1    |                       |                  |              |   |
|   | 302, |                       |                  |              |   |
|   | 3    |                       |                  |              |   |
|   | 301, |                       |                  |              |   |
|   | 3    |                       |                  |              |   |
|   | 302, |                       |                  |              |   |
|   | 3304 |                       |                  |              |   |
|   | and  |                       |                  |              |   |
|   | 7201 |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | T    |                       |                  |              |   |
|   | itle |                       |                  |              |   |
|   | 5n   |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | the  |                       |                  |              |   |
|   | U.S. |                       |                  |              |   |
|   | C    |                       |                  |              |   |
|   | ode; |                       |                  |              |   |
|   | Sec  |                       |                  |              |   |
|   | tion |                       |                  |              |   |
|   | 2    |                       |                  |              |   |
|   | 000e |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | T    |                       |                  |              |   |
|   | itle |                       |                  |              |   |
|   | 42   |                       |                  |              |   |
|   | U.S. |                       |                  |              |   |
|   | C    |                       |                  |              |   |
|   | ode: |                       |                  |              |   |
|   | and  |                       |                  |              |   |
|   | Sec  |                       |                  |              |   |
|   | tion |                       |                  |              |   |
|   | 791  |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | T    |                       |                  |              |   |
|   | itle |                       |                  |              |   |
|   | 29   |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | the  |                       |                  |              |   |
|   | U.S. |                       |                  |              |   |
|   | C    |                       |                  |              |   |
|   | ode. |                       |                  |              |   |
|   |      |                       |                  |              |   |
|   | Soli |                       |                  |              |   |
|   | cita |                       |                  |              |   |
|   | tion |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | your |                       |                  |              |   |
|   | So   |                       |                  |              |   |
|   | cial |                       |                  |              |   |
|   | Secu |                       |                  |              |   |
|   | rity |                       |                  |              |   |
|   | Nu   |                       |                  |              |   |
|   | mber |                       |                  |              |   |
|   | (    |                       |                  |              |   |
|   | SSN) |                       |                  |              |   |
|   | is   |                       |                  |              |   |
|   | au   |                       |                  |              |   |
|   | thor |                       |                  |              |   |
|   | ized |                       |                  |              |   |
|   | by   |                       |                  |              |   |
|   | E    |                       |                  |              |   |
|   | xecu |                       |                  |              |   |
|   | tive |                       |                  |              |   |
|   | O    |                       |                  |              |   |
|   | rder |                       |                  |              |   |
|   | 9397 |                       |                  |              |   |
|   | (    |                       |                  |              |   |
|   | Nove |                       |                  |              |   |
|   | mber |                       |                  |              |   |
|   | 22,  |                       |                  |              |   |
|   | 19   |                       |                  |              |   |
|   | 43), |                       |                  |              |   |
|   | w    |                       |                  |              |   |
|   | hich |                       |                  |              |   |
|   | requ |                       |                  |              |   |
|   | ires |                       |                  |              |   |
|   | agen |                       |                  |              |   |
|   | cies |                       |                  |              |   |
|   | to   |                       |                  |              |   |
|   | use  |                       |                  |              |   |
|   | the  |                       |                  |              |   |
|   | SSN  |                       |                  |              |   |
|   | as   |                       |                  |              |   |
|   | the  |                       |                  |              |   |
|   | m    |                       |                  |              |   |
|   | eans |                       |                  |              |   |
|   | for  |                       |                  |              |   |
|   | ide  |                       |                  |              |   |
|   | ntif |                       |                  |              |   |
|   | ying |                       |                  |              |   |
|   | ind  |                       |                  |              |   |
|   | ivid |                       |                  |              |   |
|   | uals |                       |                  |              |   |
|   | in   |                       |                  |              |   |
|   | P    |                       |                  |              |   |
|   | erso |                       |                  |              |   |
|   | nnel |                       |                  |              |   |
|   | inf  |                       |                  |              |   |
|   | orma |                       |                  |              |   |
|   | tion |                       |                  |              |   |
|   | syst |                       |                  |              |   |
|   | ems. |                       |                  |              |   |
|   | It   |                       |                  |              |   |
|   | will |                       |                  |              |   |
|   | be   |                       |                  |              |   |
|   | used |                       |                  |              |   |
|   | only |                       |                  |              |   |
|   | for  |                       |                  |              |   |
|   | that |                       |                  |              |   |
|   | purp |                       |                  |              |   |
|   | ose. |                       |                  |              |   |
|   | Su   |                       |                  |              |   |
|   | bmis |                       |                  |              |   |
|   | sion |                       |                  |              |   |
|   | of   |                       |                  |              |   |
|   | your |                       |                  |              |   |
|   | SSN  |                       |                  |              |   |
|   | is   |                       |                  |              |   |
|   | v    |                       |                  |              |   |
|   | olun |                       |                  |              |   |
|   | tary |                       |                  |              |   |
|   | and  |                       |                  |              |   |
|   | fai  |                       |                  |              |   |
|   | lure |                       |                  |              |   |
|   | to   |                       |                  |              |   |
|   | fur  |                       |                  |              |   |
|   | nish |                       |                  |              |   |
|   | your |                       |                  |              |   |
|   | SSN  |                       |                  |              |   |
|   | on   |                       |                  |              |   |
|   | this |                       |                  |              |   |
|   | form |                       |                  |              |   |
|   | will |                       |                  |              |   |
|   | have |                       |                  |              |   |
|   | no   |                       |                  |              |   |
|   | ef   |                       |                  |              |   |
|   | fect |                       |                  |              |   |
|   | on   |                       |                  |              |   |
|   | your |                       |                  |              |   |
|   | appl |                       |                  |              |   |
|   | icat |                       |                  |              |   |
|   | ion. |                       |                  |              |   |
+---+------+-----------------------+------------------+--------------+---+
| V |      |                       | Position Title,  |              |   |
| a |      |                       | Series, Grade    |              |   |
| c |      |                       |                  |              |   |
| a |      |                       |                  |              |   |
| n |      |                       |                  |              |   |
| c |      |                       |                  |              |   |
| y |      |                       |                  |              |   |
| A |      |                       |                  |              |   |
| n |      |                       |                  |              |   |
| n |      |                       |                  |              |   |
| o |      |                       |                  |              |   |
| u |      |                       |                  |              |   |
| n |      |                       |                  |              |   |
| c |      |                       |                  |              |   |
| e |      |                       |                  |              |   |
| m |      |                       |                  |              |   |
| e |      |                       |                  |              |   |
| n |      |                       |                  |              |   |
| t |      |                       |                  |              |   |
| N |      |                       |                  |              |   |
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+---+------+-----------------------+------------------+--------------+---+
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+---+------+-----------------------+------------------+--------------+---+
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+---+------+-----------------------+------------------+--------------+---+
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+---+------+-----------------------+------------------+--------------+---+
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| . |      |                       |                  |              |   |
+---+------+-----------------------+------------------+--------------+---+

<table style="width:100%;">
<colgroup>
<col style="width: 4%" />
<col style="width: 11%" />
<col style="width: 7%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 9%" />
<col style="width: 4%" />
<col style="width: 19%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 21%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="2"><h1 id="doe-f-1600.7e-1">DOE F 1600.7e</h1>
<p><em>(02-94)</em></p></td>
<td colspan="9"><strong>U.S. DEPARTMENT OF ENERGY</strong></td>
<td><p><em>Electronic Form Approved</em></p>
<p><em>By CIL 07/14/1999</em></p></td>
</tr>
<tr class="even">
<td colspan="12"><strong>APPLICANT DISABILITY, RACE/NATIONAL ORIGIN AND
SEX IDENTIFICATION</strong></td>
</tr>
<tr class="odd">
<td colspan="12"><ol start="67" type="1">
<li><p>Partial paralysis of one side of the body, including one arm and
one leg.</p></li>
</ol>
<p>68. Partial paralysis of three or more major parts of the body (arms
and legs)</p>
<p>71. Complete paralysis of both hands or both arms or both legs.</p>
<ol start="72" type="1">
<li><p>Complete paralysis of one arm or one leg.</p></li>
</ol>
<ol start="76" type="1">
<li><p>Complete paralysis of lower half of body, including
legs.</p></li>
<li><p>Complete paralysis of one side of body, including one arm and one
leg.</p></li>
<li><p>Complete paralysis of three or more major parts (of body) (arms
and legs).</p></li>
</ol>
<ol start="82" type="1">
<li><p>Convulsive disorder (e.g. epilepsy).</p></li>
</ol>
<ol start="90" type="1">
<li><p>Mental retardation (a chronic and lifelong condition involving a
limited ability to learn, to be educated, and to be trained for useful
productive employment as certified by a state vocational rehabilitation
agency).</p></li>
<li><p>Mental or emotional illness (a history of treatment for mental or
emotional problems).</p></li>
<li><p>Severe distortion of limbs and/or spine (e.g. dwarfism, severe
distortion of the back).</p></li>
</ol>
<p>06. I have a disability, but it is not listed above.
Describe:</p></td>
</tr>
<tr class="even">
<td colspan="12">SECTION B. RACE/NATIONAL ORIGIN</td>
</tr>
<tr class="odd">
<td colspan="12">The categories below provide descriptions of race and
national origins. Read the descriptions and then check the box next to
the category with which you identify yourself. If you are a mixed race
and/or national origin, select the category with which you identify
yourself. NOTE: Please mark only <u>ONE</u> box.</td>
</tr>
<tr class="even">
<td colspan="5"><ol type="A">
<li><p>American Indian or</p></li>
</ol>
<blockquote>
<p>Alaskan Native</p>
</blockquote></td>
<td></td>
<td colspan="6">A person having origins in any of the original peoples
of North America, and who maintains cultural identification through
community recognition or tribal affiliation.</td>
</tr>
<tr class="odd">
<td colspan="5"><ol start="2" type="A">
<li><p>Asian or Pacific</p></li>
</ol>
<blockquote>
<p>Islander</p>
</blockquote></td>
<td></td>
<td colspan="6">A person having origins in any of the original peoples
of the Far East, Southeast Asia, the India subcontinent, or the Pacific
Islands. For example: China, India, Japan, Korea, the Philippine
Islands, Samoa and Vietnam.</td>
</tr>
<tr class="even">
<td colspan="5"><ol start="3" type="A">
<li><p>Black, not of</p></li>
</ol>
<p>Hispanic origin</p></td>
<td></td>
<td colspan="6">A person having origins in any of the black racial
groups of Africa. This does not include persons of Mexican, Puerto
Rican, Cuban, Central or South American, or other Spanish cultures or
origins.</td>
</tr>
<tr class="odd">
<td colspan="5"><ol start="4" type="A">
<li><p>Hispanic</p></li>
</ol></td>
<td></td>
<td colspan="6">A person of Mexican, Puerto Rican, Cuban, Central or
South American, or other Spanish cultures or origins. This does not
include persons of Portuguese culture or origin.</td>
</tr>
<tr class="even">
<td colspan="5"><ol start="5" type="A">
<li><p>White, not of</p></li>
</ol>
<p>Hispanic origin</p></td>
<td></td>
<td colspan="6">A person having origins in any of the original peoples
of Europe, North Africa or the Middle East. This does not include
persons of Mexican, Puerto Rican, Cuban, Central or South American
cultures of origins.</td>
</tr>
<tr class="odd">
<td colspan="5"><ol start="6" type="A">
<li><p>Other</p></li>
</ol></td>
<td></td>
<td colspan="6">A person not included in the above categories.</td>
</tr>
<tr class="even">
<td colspan="12">In order for us to assess the effectiveness of our
Recruitment efforts please identify how you learned about this job by
marking the appropriate box and providing the name of the source:</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">Internet web-site</td>
<td></td>
<td colspan="3">Newspaper Ad</td>
<td></td>
<td>Trade Journal</td>
<td></td>
<td colspan="2">Other (Please indicate)</td>
</tr>
</tbody>
</table>

**Declaration for Federal Employment**

<table>
<colgroup>
<col style="width: 3%" />
<col style="width: 24%" />
<col style="width: 13%" />
<col style="width: 2%" />
<col style="width: 15%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 13%" />
<col style="width: 6%" />
<col style="width: 6%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="6"><h3 id="general-information">GENERAL
INFORMATION</h3></td>
<td colspan="7"></td>
</tr>
<tr class="even">
<td colspan="6"><ol type="1">
<li><p><strong>FULL NAME</strong> <em>(First, middle,
last)</em></p></li>
</ol></td>
<td colspan="7"><ol start="2" type="1">
<li><p><strong>SOCIAL SECURITY NUMBER</strong></p></li>
</ol></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="5"><strong>     </strong></td>
<td></td>
<td colspan="6"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="6"><ol start="3" type="1">
<li><p><strong>PLACE OF BIRTH</strong> <em>(Include City and State or
Country)</em></p></li>
</ol></td>
<td colspan="7"><ol start="4" type="1">
<li><p><strong>DATE OF BIRTH</strong> <em>(MM/DD/YY)</em></p></li>
</ol></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="5"><strong>     </strong></td>
<td></td>
<td colspan="6"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="6"><ol start="5" type="1">
<li><p><strong>OTHER NAMES EVER USED</strong> <em>(For example, maiden
name, nickname, etc.)</em></p></li>
</ol></td>
<td colspan="7"><ol start="6" type="1">
<li><p><strong>PHONE NUMBERS</strong> <em>(Include Area
Codes)</em></p></li>
</ol></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="5" rowspan="2"><strong>     </strong></td>
<td colspan="2">DAY</td>
<td colspan="2"></td>
<td colspan="3"><strong>     </strong></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">NIGHT</td>
<td colspan="2"></td>
<td colspan="3"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="13"><h2 id="selective-service-registration"><em>Selective
Service Registration</em></h2>
<p>If you are a male born after December 31, 1959, and are at least 18
years of age, civil service employment law (5 U.S.C. 3328) requires that
you must register with the Selective Service System, unless you meet
certain exemptions.</p></td>
</tr>
<tr class="even">
<td colspan="3"><h4
id="a.-are-you-a-male-born-after-december-31-1959">7a. Are you a male
born after December 31, 1959?</h4></td>
<td colspan="4"> YES</td>
<td colspan="6"> NO <em>If “NO” skip 7b and 7c. If “YES” go to
7b.</em></td>
</tr>
<tr class="odd">
<td colspan="3"><h4
id="b.-have-you-registered-with-the-selective-service-system">7b. Have
you registered with the Selective Service System?</h4></td>
<td colspan="4"> YES</td>
<td colspan="6"> NO <em>If “NO” go to 7c.</em></td>
</tr>
<tr class="even">
<td colspan="3"><h4 id="c.-if-no-describe-your-reasons-in-item-16.">7c.
If “NO”, describe your reason(s) in item #16.</h4></td>
<td colspan="10"></td>
</tr>
<tr class="odd">
<td colspan="13"><h3 id="military-service">MILITARY SERVICE</h3></td>
</tr>
<tr class="even">
<td colspan="3">8. Have you served in the United States Military?</td>
<td colspan="6"><h4 id="yes-provide-information-below"> YES <em>Provide
information below</em></h4></td>
<td colspan="4"><h4 id="no"> NO</h4></td>
</tr>
<tr class="odd">
<td colspan="13"><p>If you answered “YES”, list the branch, dates, and
type of discharge for all active duty.</p>
<p>If your only active duty was training in the Reserves or National
Guard, answer “NO”.</p></td>
</tr>
<tr class="even">
<td colspan="2"><strong>BRANCH</strong></td>
<td colspan="2"><p><strong>FROM</strong></p>
<p>MM/DD/YYYY</p></td>
<td><p><strong>TO</strong></p>
<p>MM/DD/YYYY</p></td>
<td colspan="8"><h5 id="type-of-discharge">TYPE OF DISCHARGE</h5></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="8"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="8"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="8"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="8"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="13"><h3 id="background-information">BACKGROUND
INFORMATION</h3></td>
</tr>
<tr class="even">
<td colspan="13"><strong>For all questions</strong>, <strong>provide all
additional requested information under item 16 or on attached
sheets</strong>. The circumstances of each event you list will be
considered. However, in most cases you can still be considered for
Federal jobs.</td>
</tr>
<tr class="odd">
<td colspan="13">For questions 9, 10, and 11, your answers should
include convictions resulting from a plea of nolo contendere <em>(no
contest),</em> but omit (1) traffic fines of $300 or less, (2) any
violation of law committed before your 16th birthday, (3) any violation
of law committed before your 18th birthday if finally decided in
juvenile court or under a Youth Offender law (4) any conviction set
aside under the Federal Youth Corrections Act or similar State law, and
(5) any conviction whose record was expunged under Federal or State
law.</td>
</tr>
<tr class="even">
<td colspan="11" rowspan="2">9. During the last 10 years, have you been
convicted, been imprisoned, been on probation, or been on parole?
(Includes felonies, firearms or explosives, violations, misdemeanors,
and all other offenses.) <em>If “YES”, use item 16 to provide the date,
explanation of the violation, place of occurrence, and the name and
address of the police department or court involved.</em></td>
<td><strong>YES</strong></td>
<td><strong>NO</strong></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="11" rowspan="2">10. Have you been convicted by a military
court-marital in the past 10 years? (If no military service, answer
“NO”.) <em>If “YES”, use item 16 to provide the date, explanation of the
violation, place of occurrence, and the name and address of the military
authority or court involved.</em></td>
<td><strong>YES</strong></td>
<td><strong>NO</strong></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="11" rowspan="2">11. Are you now under charges for any
violation of law? <em>If “YES”, use item 16 to provide the date,
explanation of the violation, place of occurrence, and name and address
of the police department or court involved.</em></td>
<td><strong>YES</strong></td>
<td><strong>NO</strong></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="11" rowspan="2">12. During the last 5 years, were you fired
from any job for any reason, did you quit after being told that you
would be fired, did you leave any job by mutual agreement because of
specific problems, or were you debarred form Federal employment by the
Office of Personnel Management? <em>If “YES”, use item 16 to provide the
date, an explanation of the problem and reason for leaving, and the
employer’s name and address.</em></td>
<td><strong>YES</strong></td>
<td><strong>NO</strong></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="11" rowspan="2">13. Are you delinquent on any Federal debt?
(Includes delinquencies arising from Federal taxes, loans overpayment of
benefits, and other debts to the U.S. Government, plus defaults of
Federally guaranteed or insured loans such as student and home mortgage
loans.) <em>If “YES”, use item 16 to provide the type, length, and
amount of the delinquency or default, and steps that you are taking to
correct the error or repay the debt.</em></td>
<td><strong>YES</strong></td>
<td><strong>NO</strong></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
</tr>
</tbody>
</table>

**Declaration for Federal Employment**

<table style="width:100%;">
<colgroup>
<col style="width: 20%" />
<col style="width: 15%" />
<col style="width: 9%" />
<col style="width: 2%" />
<col style="width: 5%" />
<col style="width: 15%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 7%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 5%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="8"><h3 id="section-5"></h3></td>
<td colspan="5"><p id="electronic-form-approved"
class="heading">Electronic Form Approved </p>
<p><em>by CILR 07/24/02</em></p></td>
</tr>
<tr class="even">
<td colspan="11"><h3 id="additional-questions">ADDITIONAL
QUESTIONS</h3></td>
<td><strong>YES</strong></td>
<td><strong>NO</strong></td>
</tr>
<tr class="odd">
<td colspan="11">14. Do any of your relatives work for the agency or
organization to which you are submitting this form? (Includes father,
mother, husband, wife, son, daughter, brother, sister, uncle, aunt,
first cousin, nephew, niece, father-in-law, mother-in-law, son in-law,
daughter-in-law, brother-in-law, sister-in-law, stepfather, stepson,
stepdaughter, stepbrother, stepsister, halfbrother, and halfsister.)
<em>If “YES”, use item 15 to provide the name, relationship, and the
Department, Agency, or Branch of the Armed Forces for which your
relative works.</em></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="11" rowspan="2">15. Do you receive, or have you ever
applied for, retirement pay, pension, or other pay based on military,
Federal civilian, or District of Columbia Government service?</td>
<td><h6 id="yes">YES</h6></td>
<td><strong>NO</strong></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="13"><h3
id="continuation-spaceagency-optional-questions">CONTINUATION
SPACE/AGENCY OPTIONAL QUESTIONS</h3></td>
</tr>
<tr class="odd">
<td colspan="13">16. Provide details requested items 7 through 15 and
18c in the continuation space below or on attached sheets. Be sure to
identify attached sheets with your name, Social Security Number, and
item number, and to include ZIP Codes in all addresses. If any questions
are printed below, please answer as instructed <em>(these questions are
specific to your position and your agency is authorized to ask
them).</em></td>
</tr>
<tr class="even">
<td colspan="13"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="13"><h3
id="certificationsadditional-questions">CERTIFICATIONS/ADDITIONAL
QUESTIONS</h3></td>
</tr>
<tr class="even">
<td colspan="13"><strong><em>APPLICANT</em>: If you are applying for a
position and have not yet been selected,</strong> carefully review your
answers on this form and any attached sheets. When this form and all
attached materials are accurate, read item 17, and complete 17a.</td>
</tr>
<tr class="odd">
<td colspan="13"><strong><em>APPOINTEE:</em> If you are being
appointed</strong>, carefully review your answers on this form and any
attached sheets, including any other application materials that your
agency has attached to this form. If any information requires correction
to be accurate as of the date you are signing, make changes on this form
or the attachments and/or provide updated information on additional
sheets, initialing and dating all changes and additions. When this form
and attached materials are accurate, read item 17, and answer 18a, 18b,
and 18c as appropriate.</td>
</tr>
<tr class="even">
<td colspan="13">17. <strong>I certify</strong> that, to the best of my
knowledge and belief, all of the information on and attached to this
Declaration for Federal Employment, including any attached application
materials, is true, correct, complete, and made in good faith. <strong>I
understand</strong> <strong>that a false or fraudulent answer to any
question on any part of this declaration or its attachments 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</strong> that any
information I give may be investigated for purposes of determining
eligibility for Federal employment by as allowed by law or Presidential
order. <strong>I consent</strong> to the release of information about my
ability and fitness for Federal employment by employers, schools, law
enforcement agencies, and other individuals and organizations to
investigators<em>,</em> personnel specialists, and other authorized
employees of the Federal Government<em>.</em> <strong>I
understand</strong> that for financial or lending institutions, medical
institutions, hospitals, health care professionals, and some other
sources of information, a separate specific release may be needed, and I
may be contacted for such a release at a later date.</td>
</tr>
<tr class="odd">
<td>17a. Applicant’s Signature:</td>
<td colspan="3"><em>(Sign in ink)</em></td>
<td><h4 id="section-6"></h4>
<h4 id="date">Date</h4></td>
<td colspan="2"></td>
<td colspan="6" rowspan="2"><p><strong>APPOINTING
OFFICER:</strong><br />
Enter Date of Appointment or Conversion</p>
<p>MM/DD/YYYY</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="even">
<td rowspan="2">17b. Appointee’s Signature:</td>
<td colspan="3" rowspan="2"><em>(Sign in ink)</em></td>
<td rowspan="2"><strong>Date</strong></td>
<td colspan="2" rowspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="13">18. <strong>Appointee (Only Respond only if you have
been employed by the Federal Government before):</strong> Your elections
of life insurance during previous Federal employment may affect your
eligibility for life insurance during your new appointment. These
questions are asked to help your personnel office make a correct
determination.</td>
</tr>
<tr class="odd">
<td colspan="2">18a. When did you leave your last Federal job?</td>
<td></td>
<td colspan="10">MM / DD / YYYY</td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td>DATE:</td>
<td colspan="10"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="6" rowspan="2">18b. When you worked for the Federal
Government the last time, did you waive Basic Life Insurance or any type
of optional life insurance?</td>
<td colspan="3"><strong>YES</strong></td>
<td><strong>NO</strong></td>
<td colspan="3"><strong>DO NOT KNOW</strong></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="6" rowspan="2"><p>18c. If you answered “Yes” to item 18b,
did you later cancel the waiver(s)? If your answer to item</p>
<p>18c is “No”, use item 16 to identify the type(s) of insurance for
which waivers which were not cancelled.</p></td>
<td colspan="3"><h6 id="yes-1">YES</h6></td>
<td><h6 id="no-1">NO</h6></td>
<td colspan="3"><strong>DO NOT KNOW</strong></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td></td>
<td colspan="3"></td>
</tr>
</tbody>
</table>

<table style="width:100%;">
<colgroup>
<col style="width: 11%" />
<col style="width: 28%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 8%" />
<col style="width: 1%" />
<col style="width: 12%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 17%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="2" rowspan="8"><p>OMB Approval</p>
<p>#1910-1100</p>
<p>07/04</p>
<p><strong>United States Department of Energy</strong></p>
<p><strong>Bonneville Power Administration</strong></p>
<p><strong>Supplemental Questionnaire for all</strong></p>
<h5 id="electrical-apprenticeships">Electrical Apprenticeships</h5></td>
<td rowspan="8"></td>
<td colspan="10"><strong>     </strong></td>
<td></td>
<td colspan="3">     </td>
</tr>
<tr class="even">
<td colspan="10"><strong>Name</strong></td>
<td></td>
<td colspan="3"><strong>Social Security Number</strong></td>
</tr>
<tr class="odd">
<td colspan="14"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="14"><strong>Street Address/P.O. Box</strong></td>
</tr>
<tr class="odd">
<td colspan="12"><strong>     </strong></td>
<td></td>
<td><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="12"><strong>City/State</strong></td>
<td></td>
<td><strong>Zip Code</strong></td>
</tr>
<tr class="odd">
<td colspan="4"><strong>     </strong></td>
<td></td>
<td><strong>     </strong></td>
<td></td>
<td colspan="7"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="4"><strong>Telephone</strong> <em>(Day)</em></td>
<td></td>
<td><em>(Evening/Cellular)</em></td>
<td></td>
<td colspan="7"><strong>Electronic-mail address</strong></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3" rowspan="2"><strong>Please check the box(s) for all
electrical apprenticeship positions for which you are
applying:</strong></td>
<td></td>
<td></td>
<td colspan="5"><strong>Apprentice Electrician</strong></td>
<td></td>
<td colspan="5"><strong>Apprentice Substation Operator</strong></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="5"><strong>Apprentice Lineman</strong></td>
<td></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td colspan="17"></td>
</tr>
</tbody>
</table>

**Applicant Foreword:** The completion of this supplemental
questionnaire is [mandatory]{.underline}. The information requested is
needed to evaluate your relative ability to perform the duties of an
electrical apprentice. Please fully complete the entire questionnaire
answering each question completely and accurately. Your responses must
reflect your actual knowledge and skills. You can obtain an electronic
version (can be completed using a personal computer) of this form on
BPA's jobs web page at <http://www.jobs.bpa.gov/How_To_Apply/forms.cfm>.
[If completing the question electronically, it is recommended that you
do NOT use all capital letters since this will significantly reduce the
amount of space available for you to record your answers]{.underline}.

**Drug and Alcohol Testing Notice**: In accordance with DOE Order
3792.3, this position is subject to random drug testing. If offered a
position, you will be tested for the use of illegal drugs prior to
beginning work, and are subject to periodic unannounced random drug
testing while employed. A determination of illegal drug use will result
in non-selection and withdrawal of an employment offer, based upon your
failure to meet a condition of employment. While employed, failure to
pass a random or post-accident drug test may result in disciplinary
action, up to and including removal from the Federal Service. If the
position you are selected for requires the operation of equipment
requiring a commercial driver's license (CDL), you are subject to random
alcohol testing under Department of Transportation regulations.

**Privacy Act Information**: The Bonneville Power Administration is
authorized to evaluate applicants for Federal jobs under the provisions
of Title 5, United States Code, chapter 11, sections 1104, 1302, 3301,
and 3304. The information you provide will be used to determine your
qualifications for these positions. If you do not complete the
information listed, [we will be unable to rate your
application]{.underline}, and you will [not]{.underline} be considered
for these positions.

+---+---+-----------------------------+---+---+---+---+-------------------------+---+
| * |   |                             |   |   |   |   |                         |   |
| * |   |                             |   |   |   |   |                         |   |
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| a |   |                             |   |   |   |   |                         |   |
| t |   |                             |   |   |   |   |                         |   |
| i |   |                             |   |   |   |   |                         |   |
| o |   |                             |   |   |   |   |                         |   |
| n |   |                             |   |   |   |   |                         |   |
| f |   |                             |   |   |   |   |                         |   |
| o |   |                             |   |   |   |   |                         |   |
| r |   |                             |   |   |   |   |                         |   |
| t |   |                             |   |   |   |   |                         |   |
| h |   |                             |   |   |   |   |                         |   |
| e |   |                             |   |   |   |   |                         |   |
| s |   |                             |   |   |   |   |                         |   |
| e |   |                             |   |   |   |   |                         |   |
| p |   |                             |   |   |   |   |                         |   |
| o |   |                             |   |   |   |   |                         |   |
| s |   |                             |   |   |   |   |                         |   |
| i |   |                             |   |   |   |   |                         |   |
| t |   |                             |   |   |   |   |                         |   |
| i |   |                             |   |   |   |   |                         |   |
| o |   |                             |   |   |   |   |                         |   |
| n |   |                             |   |   |   |   |                         |   |
| s |   |                             |   |   |   |   |                         |   |
| . |   |                             |   |   |   |   |                         |   |
| * |   |                             |   |   |   |   |                         |   |
| * |   |                             |   |   |   |   |                         |   |
| * |   |                             |   |   |   |   |                         |   |
+---+---+-----------------------------+---+---+---+---+-------------------------+---+
| * | * | **Work Condition**          | # | * |   |   | **Working Condition**   |   |
| * | * |                             | # | * |   |   |                         |   |
| Y | N |                             | # | N |   |   |                         |   |
| e | o |                             | # | o |   |   |                         |   |
| s | * |                             |   | * |   |   |                         |   |
| * | * |                             | Y | * |   |   |                         |   |
| * |   |                             | e |   |   |   |                         |   |
|   |   |                             | s |   |   |   |                         |   |
|   |   |                             |   |   |   |   |                         |   |
|   |   |                             | { |   |   |   |                         |   |
|   |   |                             | # |   |   |   |                         |   |
|   |   |                             | y |   |   |   |                         |   |
|   |   |                             | e |   |   |   |                         |   |
|   |   |                             | s |   |   |   |                         |   |
|   |   |                             | - |   |   |   |                         |   |
|   |   |                             | 2 |   |   |   |                         |   |
|   |   |                             | } |   |   |   |                         |   |
+---+---+-----------------------------+---+---+---+---+-------------------------+---+
|   |   | Work with frequent          |   |   |   |   | Work from high places   |   |
|   |   | overnight travel (11 or     |   |   |   |   | (15 feet and above)     |   |
|   |   | more nights per month)      |   |   |   |   |                         |   |
+---+---+-----------------------------+---+---+---+---+-------------------------+---+
|   |   | Work when subject to        |   |   |   |   | Work around hazardous   |   |
|   |   | emergency call-outs (i.e.,  |   |   |   |   | materials (i.e.,        |   |
|   |   | call to perform emergency   |   |   |   |   | solvents, PCB\'s,       |   |
|   |   | work outside normal working |   |   |   |   | chemicals, etc.)        |   |
|   |   | hours)                      |   |   |   |   |                         |   |
+---+---+-----------------------------+---+---+---+---+-------------------------+---+
|   |   | Work extended periods of    |   |   |   |   | Work around             |   |
|   |   | overtime, including working |   |   |   |   | herbicides/pesticides   |   |
|   |   | weekends.                   |   |   |   |   |                         |   |
+---+---+-----------------------------+---+---+---+---+-------------------------+---+
|   |   | Work under varying climatic |   |   |   |   | Work with a team or as  |   |
|   |   | (rain, snow, ice, high      |   |   |   |   | a member of a crew      |   |
|   |   | winds, etc.) conditions     |   |   |   |   |                         |   |
+---+---+-----------------------------+---+---+---+---+-------------------------+---+
|   |   | Work around energized high  |   |   |   |   | Work in close and       |   |
|   |   | voltage (above 12.5kv)      |   |   |   |   | confined places         |   |
|   |   | equipment.                  |   |   |   |   |                         |   |
+---+---+-----------------------------+---+---+---+---+-------------------------+---+
|   |   | Work around moving          |   |   |   |   | Work with respirator or |   |
|   |   | machinery                   |   |   |   |   | full face mask          |   |
+---+---+-----------------------------+---+---+---+---+-------------------------+---+
|   |   | Work from ladders and       |   |   |   |   | Work alone in isolated  |   |
|   |   | scaffolds                   |   |   |   |   | locations               |   |
+---+---+-----------------------------+---+---+---+---+-------------------------+---+
|   |   |                             |   |   |   |   |                         |   |
|   |   |                             |   |   |   |   |                         |   |
|   |   |                             |   |   |   |   |                         |   |
|   |   |                             |   |   |   |   |                         |   |
|   |   |                             |   |   |   |   |                         |   |
+---+---+-----------------------------+---+---+---+---+-------------------------+---+
|   |   |                             |   |   |   | N |                         |   |
|   |   |                             |   |   |   | a |                         |   |
|   |   |                             |   |   |   | m |                         |   |
|   |   |                             |   |   |   | e |                         |   |
+---+---+-----------------------------+---+---+---+---+-------------------------+---+

**[Instructions]{.underline}**

This form will be used to collect information pertaining to your
knowledge, skill, and ability for some of the job elements for the
position(s) for which you are applying. The intent of the questionnaire
is *not* to measure your ability to write; therefore, if a question can
be answered with a simple "Yes" or "No," you should do so. If you
answer, "Yes," you will be asked to write a short descriptive
explanation. If you fail to provide an explanation for an answer you
will not receive credit for the response. If you use pen and ink to
complete the questionnaire, be sure that your responses are legible.
Each question should be completed separately, so DO NOT use \"ditto
marks\" or references to answers in other questions. If you need more
space to complete an answer, indicated continued on *page 8*, and use
the space provided to complete your answer. You're advised that
statements made on your resume, application, and this form are be
subject to verification by contact with former employers.

\"WHEN\" can be answered by month and year, e.g., October 1968, or if
covering several years for example, by \"09/68 - 10/72.\"

\"HOW MANY HOURS\" OR \"HOW OFTEN\" can be answered, for example, by
writing \"full-time," or the total approximate number of hours, weeks or
months spent performing the particular activity.

\"WHO FOR,\" \"WHAT COMPANY,\" OR \"WHERE\" can be answered by name of
school attended, company, or employer, or \"at home\" or \"self.\"

\"PURPOSE,\" \"METHOD,\" \"HOW,\" etc., can be answered sometimes by
very few words, such as \"used broom to sweep out work area.\"

+-----------------------------------------------------------------------+
| ######## Disqualifying Driving Records                                |
|                                                                       |
| Within the past **[THREE]{.underline}** years, any of the following   |
| conditions ***disqualify*** an applicant for a U. S. Government Motor |
| Vehicle Authorization and the position(s) for which you are applying: |
|                                                                       |
| 1.  Conviction for operating a motor vehicle under the influence of   |
|     alcohol or a controlled substance.                                |
|                                                                       |
| 2.  Conviction for leaving the scene of an accident without making    |
|     his or her identity known.                                        |
|                                                                       |
| 3.  Driver license suspended, revoked, or canceled.                   |
|                                                                       |
| 4.  Any recurrent record of auto accidents/incidents, traffic         |
|     violations, or arrests, which demonstrates that the employee does |
|     not have an adequate sense of responsibility. This may be shown   |
|     by any of the following:                                          |
|                                                                       |
|     -   Conviction for fleeing or attempting to elude a police        |
|         officer.                                                      |
|                                                                       |
|     -   Conviction for a felony involving the use of a motor vehicle. |
|                                                                       |
|     -   Two or more accidents in which the applicant was at fault.    |
|                                                                       |
|     -   Two or more excessive speeding violations (15 miles per hour  |
|         or more over the posted limit.)                               |
|                                                                       |
|     -   Four or more moving violations                                |
+-----------------------------------------------------------------------+

  ----------------------------------------------------------------------------------------------------
                                                                            **     **
  ---------------- ---------------- --------- -------- -------------------- --------------------------
                                                                            Name

  **Element 2 --                                                            
  Ability to                                                                
  Follow                                                                    
  Instructions**                                                            

  **Questions**                     **Yes**   **No**   **Briefly describe   
                                                       the task (i.e., what 
                                                       you were doing); how 
                                                       you received your    
                                                       instructions         
                                                       (verbal, visual, or  
                                                       written) OR type of  
                                                       equipment you were   
                                                       using** *(Questions  
                                                       1 through 9)*        

  1\.              Have you ever                                            
                   operated                                                 
                   equipment, which                                         
                   required that                                            
                   you perform                                              
                   functions in a                                           
                   precise                                                  
                   sequence?                                                

                                                                            

  2\.              Have you ever                                            
                   participated in                                          
                   a work or other                                          
                   activity where                                           
                   the use of                                               
                   specialized                                              
                   terminology was                                          
                   required?                                                

  3\.              Have you been                                            
                   responsible for                                          
                   cleaning and                                             
                   maintaining                                              
                   tools or shop                                            
                   equipment?                                               

  4\.              Have you ever                                            
                   participated in                                          
                   any activity                                             
                   that required                                            
                   you to perform a                                         
                   sequence of                                              
                   tasks as                                                 
                   directed by                                              
                   another                                                  
                   individual or                                            
                   entity?                                                  

  5\.              Have you                                                 
                   performed                                                
                   inventory or                                             
                   been responsible                                         
                   for supply                                               
                   stock?                                                   

  6\.              Have you had to                                          
                   perform detailed                                         
                   planning and                                             
                   investigation to                                         
                   complete a job                                           
                   or other                                                 
                   activity?                                                
  ----------------------------------------------------------------------------------------------------

  --------------- ---------------- --------- -------- -------------------- --------------------------
                                                                           **     **

                                                                           **Name**

  **Element 2 --                                                           
  Ability to                                                               
  Follow                                                                   
  Instructions                                                             
  (Continued)**                                                            

  **Questions**                    **Yes**   **No**   **Briefly describe   
                                                      the task (i.e., what 
                                                      you were doing); how 
                                                      you received your    
                                                      instructions         
                                                      (verbal, visual, or  
                                                      written) OR type of  
                                                      equipment you were   
                                                      using** *(Questions  
                                                      1 through 9)*        

  7\.             Have you                                                 
                  performed                                                
                  equipment                                                
                  inspection tasks                                         
                  that included                                            
                  reading gauges,                                          
                  meters, or                                               
                  dials?                                                   

                                                                           

  8\.             Have you been                                            
                  responsible for                                          
                  compiling and                                            
                  maintaining                                              
                  records?                                                 

  9\.             Have you used                                            
                  instruction                                              
                  books or manuals                                         
                  to complete                                              
                  tasks?                                                   
  --------------- ---------------- --------- -------- -------------------- --------------------------

  ------ ---------------- --------- -------- -----------------------------------------------
         **Question**     **Yes**   **No**   **Briefly describe the curriculum and the
                                             approximate number of hours completed.**

  10\.   Did you                                  
         satisfactorily                      
         complete a                          
         technical school                    
         (e.g., military,                    
         lineman, etc.)                      
         or vocational                       
         high school                         
         curriculum? If                      
         so, describe the                    
         program or                          
         curriculum.                         

  11\.   Have you had                             
         training in                         
         other technical                     
         areas such as in                    
         the military,                       
         private                             
         contractor, etc?                    
         If so, describe                     
         the type of                         
         training                            
         received.                           
  ------ ---------------- --------- -------- -----------------------------------------------

+---+---------------------+---+---+--------------+--------------------------+
|   |                     |   |   |              |                          |
+---+---------------------+---+---+--------------+--------------------------+
|   |                     |   |   |              | ### Name                 |
+---+---------------------+---+---+--------------+--------------------------+
| * |                     |   |   |              |                          |
| * |                     |   |   |              |                          |
| E |                     |   |   |              |                          |
| l |                     |   |   |              |                          |
| e |                     |   |   |              |                          |
| m |                     |   |   |              |                          |
| e |                     |   |   |              |                          |
| n |                     |   |   |              |                          |
| t |                     |   |   |              |                          |
| 3 |                     |   |   |              |                          |
| - |                     |   |   |              |                          |
| - |                     |   |   |              |                          |
| D |                     |   |   |              |                          |
| e |                     |   |   |              |                          |
| x |                     |   |   |              |                          |
| t |                     |   |   |              |                          |
| e |                     |   |   |              |                          |
| r |                     |   |   |              |                          |
| i |                     |   |   |              |                          |
| t |                     |   |   |              |                          |
| y |                     |   |   |              |                          |
| a |                     |   |   |              |                          |
| n |                     |   |   |              |                          |
| d |                     |   |   |              |                          |
| S |                     |   |   |              |                          |
| a |                     |   |   |              |                          |
| f |                     |   |   |              |                          |
| e |                     |   |   |              |                          |
| t |                     |   |   |              |                          |
| y |                     |   |   |              |                          |
| * |                     |   |   |              |                          |
| * |                     |   |   |              |                          |
+---+---------------------+---+---+--------------+--------------------------+
| * |                     | * | * | **D          |                          |
| * |                     | * | * | escription** |                          |
| Q |                     | Y | N |              |                          |
| u |                     | e | o |              |                          |
| e |                     | s | * |              |                          |
| s |                     | * | * |              |                          |
| t |                     | * |   |              |                          |
| i |                     |   |   |              |                          |
| o |                     |   |   |              |                          |
| n |                     |   |   |              |                          |
| * |                     |   |   |              |                          |
| * |                     |   |   |              |                          |
+---+---------------------+---+---+--------------+--------------------------+
| 1 | Have you worked for |   |   |              |                          |
| \ | an employer with an |   |   |              |                          |
| . | established formal  |   |   |              |                          |
|   | safety program      |   |   |              |                          |
|   | (i.e., published    |   |   |              |                          |
|   | safety manuals,     |   |   |              |                          |
|   | procedures, etc.)?  |   |   |              |                          |
|   | If so, please       |   |   |              |                          |
|   | briefly describe    |   |   |              |                          |
|   | the program.        |   |   |              |                          |
+---+---------------------+---+---+--------------+--------------------------+
| 2 | Have you ever       |   |   |              |                          |
| \ | received an award   |   |   |              |                          |
| . | or other            |   |   |              |                          |
|   | recognition for     |   |   |              |                          |
|   | your ability to     |   |   |              |                          |
|   | work safely?        |   |   |              |                          |
+---+---------------------+---+---+--------------+--------------------------+
| 3 | Have you had any    |   |   |              |                          |
| \ | safety related      |   |   |              |                          |
| . | training (CPR,      |   |   |              |                          |
|   | first aid, work     |   |   |              |                          |
|   | procedures, etc.).  |   |   |              |                          |
|   | If so, please       |   |   |              |                          |
|   | describe the type   |   |   |              |                          |
|   | of training,        |   |   |              |                          |
|   | approximate dates,  |   |   |              |                          |
|   | and number of       |   |   |              |                          |
|   | hours.              |   |   |              |                          |
+---+---------------------+---+---+--------------+--------------------------+
| 4 | Have you, in the    |   |   |              |                          |
| \ | last 5 years, had   |   |   |              |                          |
| . | an on-the-job       |   |   |              |                          |
|   | accident or injury, |   |   |              |                          |
|   | which resulted in   |   |   |              |                          |
|   | you missing work or |   |   |              |                          |
|   | school? If so, give |   |   |              |                          |
|   | dates of            |   |   |              |                          |
|   | ac                  |   |   |              |                          |
|   | cident(s)/injuries, |   |   |              |                          |
|   | details of the      |   |   |              |                          |
|   | circumstances that  |   |   |              |                          |
|   | caused the          |   |   |              |                          |
|   | accident/injury.    |   |   |              |                          |
+---+---------------------+---+---+--------------+--------------------------+
| 5 | Have you had a job  |   |   |              |                          |
| \ | that required you   |   |   |              |                          |
| . | to work from        |   |   |              |                          |
|   | heights and/or have |   |   |              |                          |
|   | you worked from     |   |   |              |                          |
|   | heights in a        |   |   |              |                          |
|   | non-job related     |   |   |              |                          |
|   | activity? If so,    |   |   |              |                          |
|   | describe in detail  |   |   |              |                          |
|   | the type of work or |   |   |              |                          |
|   | non-job related     |   |   |              |                          |
|   | activity,           |   |   |              |                          |
|   | [including the      |   |   |              |                          |
|   | approximate         |   |   |              |                          |
|   | h                   |   |   |              |                          |
|   | eights]{.underline} |   |   |              |                          |
|   | from which you have |   |   |              |                          |
|   | worked.             |   |   |              |                          |
+---+---------------------+---+---+--------------+--------------------------+

+---+----------------+---+---+------------------+----------------------------+
|   |                |   |   |                  |                            |
+---+----------------+---+---+------------------+----------------------------+
|   |                |   |   |                  | ### Name                   |
+---+----------------+---+---+------------------+----------------------------+
| * |                |   |   |                  |                            |
| * |                |   |   |                  |                            |
| E |                |   |   |                  |                            |
| l |                |   |   |                  |                            |
| e |                |   |   |                  |                            |
| m |                |   |   |                  |                            |
| e |                |   |   |                  |                            |
| n |                |   |   |                  |                            |
| t |                |   |   |                  |                            |
| 4 |                |   |   |                  |                            |
| - |                |   |   |                  |                            |
| - |                |   |   |                  |                            |
| A |                |   |   |                  |                            |
| b |                |   |   |                  |                            |
| i |                |   |   |                  |                            |
| l |                |   |   |                  |                            |
| i |                |   |   |                  |                            |
| t |                |   |   |                  |                            |
| y |                |   |   |                  |                            |
| t |                |   |   |                  |                            |
| o |                |   |   |                  |                            |
| u |                |   |   |                  |                            |
| s |                |   |   |                  |                            |
| e |                |   |   |                  |                            |
| p |                |   |   |                  |                            |
| r |                |   |   |                  |                            |
| i |                |   |   |                  |                            |
| n |                |   |   |                  |                            |
| t |                |   |   |                  |                            |
| s |                |   |   |                  |                            |
| a |                |   |   |                  |                            |
| n |                |   |   |                  |                            |
| d |                |   |   |                  |                            |
| d |                |   |   |                  |                            |
| r |                |   |   |                  |                            |
| a |                |   |   |                  |                            |
| w |                |   |   |                  |                            |
| i |                |   |   |                  |                            |
| n |                |   |   |                  |                            |
| g |                |   |   |                  |                            |
| s |                |   |   |                  |                            |
| * |                |   |   |                  |                            |
| * |                |   |   |                  |                            |
+---+----------------+---+---+------------------+----------------------------+
| * |                | * | * | **Describe how   |                            |
| * |                | * | * | you have "used"  |                            |
| H |                | Y | N | the              |                            |
| a |                | e | o | d                |                            |
| v |                | s | * | rawings/diagrams |                            |
| e |                | * | * | and for what     |                            |
| y |                | * |   | purpose. If you  |                            |
| o |                |   |   | have completed   |                            |
| u |                |   |   | c                |                            |
| u |                |   |   | ourses/training, |                            |
| s |                |   |   | indicate the     |                            |
| e |                |   |   | title of the     |                            |
| d |                |   |   | course (no       |                            |
| t |                |   |   | course codes),   |                            |
| h |                |   |   | type of          |                            |
| e |                |   |   | school/training  |                            |
| f |                |   |   | (e.g., trade     |                            |
| o |                |   |   | school,          |                            |
| l |                |   |   | military,        |                            |
| l |                |   |   | correspondence,  |                            |
| o |                |   |   | etc.) course     |                            |
| w |                |   |   | length (number   |                            |
| i |                |   |   | of hours),       |                            |
| n |                |   |   | course           |                            |
| g |                |   |   | description, and |                            |
| d |                |   |   | if you           |                            |
| r |                |   |   | successfully     |                            |
| a |                |   |   | completed the    |                            |
| w |                |   |   | course.**        |                            |
| i |                |   |   |                  |                            |
| n |                |   |   |                  |                            |
| g |                |   |   |                  |                            |
| s |                |   |   |                  |                            |
| / |                |   |   |                  |                            |
| d |                |   |   |                  |                            |
| i |                |   |   |                  |                            |
| a |                |   |   |                  |                            |
| g |                |   |   |                  |                            |
| r |                |   |   |                  |                            |
| a |                |   |   |                  |                            |
| m |                |   |   |                  |                            |
| s |                |   |   |                  |                            |
| * |                |   |   |                  |                            |
| * |                |   |   |                  |                            |
+---+----------------+---+---+------------------+----------------------------+
| 1 | Electrical     |   |   |                  |                            |
| \ | wiring         |   |   |                  |                            |
| . | diagrams       |   |   |                  |                            |
+---+----------------+---+---+------------------+----------------------------+
| 2 | Schematic      |   |   |                  |                            |
| \ | diagrams       |   |   |                  |                            |
| . |                |   |   |                  |                            |
+---+----------------+---+---+------------------+----------------------------+
| 3 | Electronic     |   |   |                  |                            |
| \ | drawings       |   |   |                  |                            |
| . |                |   |   |                  |                            |
+---+----------------+---+---+------------------+----------------------------+
| 4 | One-line       |   |   |                  |                            |
| \ | diagrams       |   |   |                  |                            |
| . |                |   |   |                  |                            |
+---+----------------+---+---+------------------+----------------------------+
| 5 | Mechanica      |   |   |                  |                            |
| \ | l/Construction |   |   |                  |                            |
| . | blueprints     |   |   |                  |                            |
+---+----------------+---+---+------------------+----------------------------+
| 6 | Maps (road,    |   |   |                  |                            |
| \ | topographic,   |   |   |                  |                            |
| . | physical,etc.) |   |   |                  |                            |
+---+----------------+---+---+------------------+----------------------------+
|   |                |   |   |                  |                            |
+---+----------------+---+---+------------------+----------------------------+
| * |                | * | * | **If you have    |                            |
| * |                | * | * | completed        |                            |
| H |                | Y | N | c                |                            |
| a |                | e | o | ourses/training, |                            |
| v |                | s | * | indicate the     |                            |
| e |                | * | * | title of the     |                            |
| y |                | * |   | course (no       |                            |
| o |                |   |   | course codes),   |                            |
| u |                |   |   | type of          |                            |
| t |                |   |   | school/training  |                            |
| a |                |   |   | (e.g., trade     |                            |
| k |                |   |   | school,          |                            |
| e |                |   |   | military,        |                            |
| n |                |   |   | correspondence,  |                            |
| c |                |   |   | etc.) course     |                            |
| o |                |   |   | length (number   |                            |
| u |                |   |   | of hours),       |                            |
| r |                |   |   | course           |                            |
| s |                |   |   | description, and |                            |
| e |                |   |   | if you           |                            |
| s |                |   |   | successfully     |                            |
| i |                |   |   | completed the    |                            |
| n |                |   |   | course.**        |                            |
| t |                |   |   |                  |                            |
| h |                |   |   |                  |                            |
| e |                |   |   |                  |                            |
| f |                |   |   |                  |                            |
| o |                |   |   |                  |                            |
| l |                |   |   |                  |                            |
| l |                |   |   |                  |                            |
| o |                |   |   |                  |                            |
| w |                |   |   |                  |                            |
| i |                |   |   |                  |                            |
| n |                |   |   |                  |                            |
| g |                |   |   |                  |                            |
| ? |                |   |   |                  |                            |
| * |                |   |   |                  |                            |
| * |                |   |   |                  |                            |
+---+----------------+---+---+------------------+----------------------------+
| 7 | AC Theory      |   |   |                  |                            |
| \ |                |   |   |                  |                            |
| . |                |   |   |                  |                            |
+---+----------------+---+---+------------------+----------------------------+
| 8 | DC Theory      |   |   |                  |                            |
| \ |                |   |   |                  |                            |
| . |                |   |   |                  |                            |
+---+----------------+---+---+------------------+----------------------------+

<table>
<colgroup>
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 18%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 18%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 5%" />
<col style="width: 15%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 20%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="9"></td>
<td colspan="4">     </td>
</tr>
<tr class="even">
<td colspan="9"></td>
<td colspan="4"><h3 id="name-2">Name</h3></td>
</tr>
<tr class="odd">
<td colspan="13"><strong>Element 5 –</strong> <strong>Ability to Use
Tools (Part A)</strong></td>
</tr>
<tr class="even">
<td colspan="13"><strong>Instructions</strong>: Check the box next to
any of the following hand tools that you have used.</td>
</tr>
<tr class="odd">
<td></td>
<td>1.</td>
<td>Screw Drivers</td>
<td></td>
<td>10.</td>
<td>Hand Saws</td>
<td></td>
<td>19.</td>
<td colspan="2">Rakes</td>
<td></td>
<td>28.</td>
<td>Hand Drill</td>
</tr>
<tr class="even">
<td></td>
<td>2.</td>
<td>Hammers</td>
<td></td>
<td>11.</td>
<td>Pipe Wrench</td>
<td></td>
<td>20.</td>
<td colspan="2">Axe or Hatchet</td>
<td></td>
<td>29.</td>
<td>Hand Sander</td>
</tr>
<tr class="odd">
<td></td>
<td>3.</td>
<td>Pliers</td>
<td></td>
<td>12.</td>
<td>Vise/Clamps</td>
<td></td>
<td>21.</td>
<td colspan="2">Taps and Dies</td>
<td></td>
<td>30.</td>
<td>Files/Rasps</td>
</tr>
<tr class="even">
<td></td>
<td>4.</td>
<td>Open-end wrenches</td>
<td></td>
<td>13.</td>
<td>Paint Brushes</td>
<td></td>
<td>22.</td>
<td colspan="2">Side Cutters</td>
<td></td>
<td>31.</td>
<td>Tin Snips</td>
</tr>
<tr class="odd">
<td></td>
<td>5.</td>
<td>Socket wrenches</td>
<td></td>
<td>14.</td>
<td>Paint Rollers</td>
<td></td>
<td>23.</td>
<td colspan="2">Rulers</td>
<td></td>
<td>32.</td>
<td>Hot Glue Gun</td>
</tr>
<tr class="even">
<td></td>
<td>6.</td>
<td>Chisels/Punches</td>
<td></td>
<td>15.</td>
<td>Ladders</td>
<td></td>
<td>24.</td>
<td colspan="2">Levels</td>
<td></td>
<td>33.</td>
<td>Staple Gun</td>
</tr>
<tr class="odd">
<td></td>
<td>7.</td>
<td>Tape Measure</td>
<td></td>
<td>16.</td>
<td>Design Templates</td>
<td></td>
<td>25.</td>
<td colspan="2">Knife Sharpener</td>
<td></td>
<td>34.</td>
<td>Miter Box</td>
</tr>
<tr class="even">
<td></td>
<td>8.</td>
<td>Adjustable Wrenches</td>
<td></td>
<td>17.</td>
<td>Drawing Compass</td>
<td></td>
<td>26.</td>
<td colspan="2">Scribes/Awls</td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td>9.</td>
<td>Squares</td>
<td></td>
<td>18.</td>
<td>Shovels</td>
<td></td>
<td>27.</td>
<td colspan="2">Chalk Line</td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="13"><strong>Part A – Section 2: Describe two or three tasks
or projects where you have used some of the tools you’ve checked in Part
A above.</strong></td>
</tr>
<tr class="odd">
<td colspan="13">     </td>
</tr>
<tr class="even">
<td colspan="13"><strong>Element 5 – Ability to Use Tools (Part
B)</strong></td>
</tr>
<tr class="odd">
<td colspan="13"><strong>Instructions</strong>: Check the box next to
any of the following power tools or equipment that you have used.</td>
</tr>
<tr class="even">
<td></td>
<td>1.</td>
<td>Circular Saw</td>
<td></td>
<td>7.</td>
<td>Power Drill</td>
<td></td>
<td>13.</td>
<td colspan="2">Bench Grinder</td>
<td></td>
<td>19.</td>
<td>Lawn Mower</td>
</tr>
<tr class="odd">
<td></td>
<td>2.</td>
<td>Table Saw</td>
<td></td>
<td>8.</td>
<td>Drill Press</td>
<td></td>
<td>14.</td>
<td colspan="2">Arc Welders</td>
<td></td>
<td>20.</td>
<td>Weed Trimmer</td>
</tr>
<tr class="even">
<td></td>
<td>3.</td>
<td>Band Saw</td>
<td></td>
<td>9.</td>
<td>Hydraulic Presses</td>
<td></td>
<td>15.</td>
<td colspan="2">Oxyacetylene (gas) welders</td>
<td></td>
<td>21.</td>
<td>Tiller</td>
</tr>
<tr class="odd">
<td></td>
<td>4.</td>
<td>Chain Saw</td>
<td></td>
<td>10.</td>
<td>Wood/Metal Lathe</td>
<td></td>
<td>16.</td>
<td colspan="2">Soldering Iron</td>
<td></td>
<td>22.</td>
<td>Personal Computer</td>
</tr>
<tr class="even">
<td></td>
<td>5.</td>
<td>Jig Saw</td>
<td></td>
<td>11.</td>
<td>Dremel Tools</td>
<td></td>
<td>17.</td>
<td colspan="2">Sewing Machine</td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td>6.</td>
<td>Power Sander</td>
<td></td>
<td>12.</td>
<td>Router</td>
<td></td>
<td>18.</td>
<td colspan="2">Vacuum Cleaner</td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="13"><strong>Part B – Section 2: Describe two or three tasks
and/or projects where you have used some of the tools described in Part
B above.</strong></td>
</tr>
<tr class="odd">
<td colspan="13">     </td>
</tr>
</tbody>
</table>

+----+----+------------------------------+---+------------------------+
| #  |    |                              |   |                        |
|    |    |                              |   |                        |
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+----+----+------------------------------+---+------------------------+
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+----+----+------------------------------+---+------------------------+
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+----+----+------------------------------+---+------------------------+
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+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
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|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+

##  {#section-8}