**PART A - EMPLOYEE INFORMATION**

Name (Last, First, Middle
Initial)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title, Series,
Grade\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Agency
Name\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Agency
Address\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Email
Address\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Phone\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Fax\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**PART B -- CERTIFICATION REQUIREMENTS**

1.  **Education**:

-    Possess a Bachelor's degree that included or was supplemented by at
    least 24 semester hours in any combination of the following fields:
    accounting, business, finance, law, contracts, purchasing,
    economics, industrial management, marketing, quantitative methods,
    or organization and management.

-    Meet OPM 1102 Exception Provision and occupied a GS-1102 position
    at Grade 13 or above on January 1, 2000.

2.  **Experienc**e:

-    Minimum of four years contracting or related experience. Actual
    number of years contracting experience\_\_\_\_\_\_\_\_.

3\. **Training requirements**:

-   Send all certificates for applicable courses below to the
    Acquisition Career Manager

-   Method of Completion: Actual, Fulfillment, or Equivalent. For course
    equivalencies, see Appendix D of the DAU Catalog
    (<http://www.dau.mil/catalog/default.asp>).

+------------------------+-------+----------+----------------+-------+
|                        | **ACT | **FULFI  | **EQUIVALENT** |       |
|                        | UAL** | LLMENT** |                |       |
+------------------------+-------+----------+----------------+-------+
| **REQUIRED TRAINING    | *     | **Date   | **Equivalent   | *     |
| COURSE**               | *Date | Ful      | (or            | *Date |
|                        | A     | fillment | Predecessor)   | Equiv |
|                        | ctual | Ap       | Course Name**  | alent |
|                        | C     | proved** |                | C     |
|                        | ourse |          |                | ourse |
|                        | C     |          |                | C     |
|                        | omple |          |                | omple |
|                        | ted** |          |                | ted** |
+------------------------+-------+----------+----------------+-------+
| **CON 353**            |       |          |                |       |
|                        |       |          |                |       |
| **ADVANCED BUSINESS    |       |          |                |       |
| SOLUTIONS FOR MISSION  |       |          |                |       |
| SUPPORT**              |       |          |                |       |
+------------------------+-------+----------+----------------+-------+

**ELECTIVE (TWO):**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Course name) (Date completed)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Course name) (Date completed)**\
**

**PART C -- PREVIOUS CERTIFICATION**

**Previously held certification from another Federal agency** *(Attach a
copy of certification)*

-   **Name of
    Agency:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

-   **Date Certification
    Issued:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**PART D -- SIGNATURES**

Applicant's
Signature\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Supervisor's Endorsement**:

I have reviewed and verified all supporting documentation and recommend
the above individual for certification at Level III.

Name\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Signature\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**COCO (or designee) Approval**:

I concur with the supervisor's endorsement and approve the above
individual for certification at Level III.

Name\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Signature\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**PART E -- CERTIFYING OFFICIAL DECISION**

Level III Certification is: Approved Disapproved
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Title\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**INSTRUCTIONS** **FOR APPLYING FOR FEDERAL ACQUISITION CERTIFICATION**
-- Fill in Application Sheet As Follows:

**PART A -- [EMPLOYEE INFORMATION]{.underline}** Applicant fills in
completely.

**PART B -- [CERTIFICATION REQUIREMENTS]{.underline}**

Check off each applicable box and write in the type of documentation you
are providing as evidence of how you meet the criteria:

1.  [Education]{.underline}: Attach copies of college transcripts
    showing degree and college courses completed.

2.  [Experience]{.underline}: Attach evidence of
    [Contracting]{.underline} experience (e.g. resume).
    [NOTE]{.underline}: If you are [not in the contracting 1102
    series]{.underline}, a written document stating that you possess the
    required years of contracting experience signed and dated by your
    supervisor must be included with your application.

3.  [Training]{.underline}: Attach evidence of successful completion of
    the mandatory contracting courses. Acceptable documentation
    includes: copies of course completion certificates, SF 182s showing
    completion, or a Defense Acquisition University transcript.

**PART C -- [PREVIOUS CERTIFICATION]{.underline}**

Provide information pertaining to previous certifications from another
Federal agency. Ensure a copy of the certification is attached to the
application.

**PART D -- [SIGNATURES]{.underline}**

The applicant, immediate supervisor, and the Chief of the Contracting
Office (COCO) are required to sign and date the application.

**PART E -- [CERTIFYING OFFICIAL DECISION]{.underline}**

The final approval (certification decision) will be made by the SPE or
designee.

**[SUBMISSION OF THE APPLICATION]{.underline}**

1.  The applicant shall complete Parts A, B and C, sign and date the
    application, and forward to his or her immediate supervisor for
    review and validation. Once the review and validation is completed,
    the immediate supervisor will sign and date in section D and forward
    the application to the COCO for approval and submission to the
    Senior Procurement Executive (or designee) for a certification
    decision and final approval.

**[QUESTIONS?:]{.underline}** Contact the DOT Acquisition Career Manager
at 202-366-4960 or email <Cassandra.Wells@dot.gov>.