<table>
<colgroup>
<col style="width: 3%" />
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<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 6%" />
<col style="width: 0%" />
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</colgroup>
<tbody>
<tr class="odd">
<td colspan="17"></td>
<td colspan="10"><strong>A.</strong> Agency, code agency subelement and
submitting office number</td>
<td><strong>01</strong></td>
<td colspan="21"><strong>B. OFFICE USE ONLY</strong></td>
</tr>
<tr class="even">
<td colspan="17"><strong>REQUEST, AUTHORIZATION, AGREEMENT</strong></td>
<td colspan="11">(Example - xx-xx-xxxx)</td>
<td colspan="21"></td>
</tr>
<tr class="odd">
<td colspan="17"><strong>AND CERTIFICATION OF TRAINING</strong></td>
<td colspan="11"></td>
<td colspan="17"><strong>C.</strong> Request status (Mark (X) one)</td>
<td colspan="4"><strong>02</strong></td>
</tr>
<tr class="even">
<td colspan="17"></td>
<td colspan="11"></td>
<td colspan="5">X</td>
<td colspan="3"><p><strong>Initial or</strong></p>
<p><strong>Resubmission</strong></p></td>
<td colspan="5"> </td>
<td colspan="8"><p><strong>Correction or</strong></p>
<p><strong>Cancellation</strong></p></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="47"><strong>Section A-TRAINEE INFORMATION</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="14"><strong>1.</strong> Applicant’s name
<em>(Last-First-Middle Initial)</em></td>
<td>Enter first 5 letters of</td>
<td colspan="2"><strong>03</strong></td>
<td colspan="9">2. Social Security Number</td>
<td colspan="2"><strong>04</strong></td>
<td colspan="16">3. Date of birth <em>(Year and month)</em></td>
<td colspan="5"><strong>05</strong></td>
</tr>
<tr class="odd">
<td colspan="14"></td>
<td colspan="3">last name</td>
<td colspan="11"></td>
<td colspan="12"></td>
<td colspan="9"><em>(Example-born</em></td>
</tr>
<tr class="even">
<td colspan="14">PUBLIC, TERRY Q.</td>
<td colspan="3"><strong>PUBLI</strong></td>
<td colspan="11"><strong>111-11-1111</strong></td>
<td colspan="12"><strong>76/07</strong></td>
<td colspan="9"><p><em>January 14, 1943</em></p>
<p><em>shown as 43/01)</em></p></td>
</tr>
<tr class="odd">
<td colspan="17"><strong>4.</strong> Home address <em>(Number, street,
city, State, ZIP code)</em></td>
<td colspan="11"><strong>5.</strong> Home telephone</td>
<td colspan="21"><strong>6.</strong> Position level <em>(Mark (X) one
only)</em></td>
</tr>
<tr class="even">
<td colspan="17">123 My Street</td>
<td colspan="6">Area code</td>
<td colspan="5">Number</td>
<td colspan="2"> </td>
<td colspan="8">a. Non-supervisory</td>
<td colspan="2"> </td>
<td colspan="9">c. Manager</td>
</tr>
<tr class="odd">
<td colspan="17">Hometown, MD 12345</td>
<td colspan="6">123</td>
<td colspan="5">456-7890</td>
<td colspan="2"> </td>
<td colspan="8">b. Supervisory</td>
<td colspan="2"> </td>
<td colspan="9">d. Executive</td>
</tr>
<tr class="even">
<td colspan="17"><strong>7.</strong> Organization mailing address
<em>(Branch-Division/Office/Bureau/Agency)</em></td>
<td colspan="11">8. Office telephone</td>
<td colspan="11"><p><strong>9.</strong> Continuous</p>
<p>civilian service</p></td>
<td colspan="10"><p>10. Number of prior</p>
<p>non-government</p></td>
</tr>
<tr class="odd">
<td colspan="17">HRO/CFO</td>
<td colspan="6">Area code</td>
<td colspan="2">Number</td>
<td colspan="3">Extension</td>
<td colspan="7">Years</td>
<td colspan="4">Months</td>
<td colspan="10">training days</td>
</tr>
<tr class="even">
<td colspan="17">ITA/DOC</td>
<td colspan="6">202</td>
<td colspan="2">123-4567</td>
<td colspan="3">    </td>
<td colspan="7">16</td>
<td colspan="4">  </td>
<td colspan="10">3</td>
</tr>
<tr class="odd">
<td colspan="11"><strong>11a.</strong> Position title/function</td>
<td colspan="5"><p><strong>11b.</strong> Applicant handi-</p>
<p>capped or disabled</p></td>
<td></td>
<td colspan="11"><strong>12.</strong> Pay plan/series/grade/step</td>
<td colspan="11"><strong>13.</strong> Type of appointment</td>
<td colspan="10"><strong>14.</strong> Education Level</td>
</tr>
<tr class="even">
<td colspan="11">Compliance Analyst</td>
<td colspan="5"><em>(See instructions)</em></td>
<td> </td>
<td colspan="11">GS-1801-12 Step 1</td>
<td colspan="11"></td>
<td colspan="10">MS</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="47"><strong>Section B-TRAINING COURSE DATA</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="17"><strong>15a.</strong> Name and mailing address of
training vendor <em>(No., street, city, State, ZIP code)</em></td>
<td colspan="21"><strong>15b</strong>. Location of training site <em>(If
same, mark box)</em></td>
<td colspan="2">X</td>
<td colspan="9"></td>
</tr>
<tr class="odd">
<td colspan="17">800 Maryland Ave</td>
<td colspan="32">Williamsburg Marriott, 123 King Street</td>
</tr>
<tr class="even">
<td colspan="17">Washington, DC 20230</td>
<td colspan="32">Williamsburg, VA 12345</td>
</tr>
<tr class="odd">
<td colspan="49"><strong>16.</strong> Course title and training
objectives <em>(Benefits to be derived by the Government)</em></td>
</tr>
<tr class="even">
<td colspan="49">Anti Dumping Convention: collaborate &amp; train with
other anti dumping specialists</td>
</tr>
<tr class="odd">
<td colspan="4"><strong>17.</strong> Catalog/Course No.</td>
<td colspan="8"><strong>18.</strong> Training Period <em>(6
digits)</em></td>
<td colspan="2"><strong>06</strong></td>
<td colspan="7"><strong>19.</strong> No. of course hours <em>(4
digits)</em></td>
<td colspan="3"><strong>07</strong></td>
<td colspan="25"><strong>20.</strong> Training codes <em>(See
instructions)</em></td>
</tr>
<tr class="even">
<td colspan="4">N/A</td>
<td colspan="3"></td>
<td colspan="2">Year</td>
<td colspan="4">Month</td>
<td>Day</td>
<td colspan="4"><strong>a.</strong> During duty</td>
<td colspan="6"><strong>24</strong></td>
<td colspan="4"></td>
<td colspan="4">Code</td>
<td colspan="10"></td>
<td>Code</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td colspan="4">     </td>
<td colspan="3"><strong>a.</strong> Start</td>
<td colspan="2">05</td>
<td colspan="4">4</td>
<td>17</td>
<td colspan="4"><strong>b.</strong> Non-duty</td>
<td colspan="6"><strong>8</strong></td>
<td colspan="4"><strong>a.</strong> Purpose</td>
<td colspan="4"></td>
<td colspan="3"><strong>08</strong></td>
<td colspan="7"><strong>c.</strong> Source</td>
<td></td>
<td colspan="6"><strong>10</strong></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="3"><strong>b.</strong> Complete</td>
<td colspan="2"><strong>05</strong></td>
<td colspan="4"><strong>4</strong></td>
<td><strong>20</strong></td>
<td colspan="4"><strong>c.</strong> TOTAL</td>
<td colspan="6">32</td>
<td colspan="4"><strong>b.</strong> Type</td>
<td colspan="4"></td>
<td colspan="3"><strong>09</strong></td>
<td colspan="7"><strong>d.</strong> Special Interest</td>
<td></td>
<td colspan="6"><strong>11</strong></td>
</tr>
<tr class="odd">
<td colspan="49">AGENCY USE ONLY</td>
</tr>
<tr class="even">
<td colspan="49"></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="15"><strong>Section C-<span class="smallcaps">ESTIMATED
COSTS AND BILLING INFORMATION</span></strong></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="25"><strong><span class="smallcaps">S</span>ection <span
class="smallcaps">D-APPROVALS</span></strong></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="19"><strong>21.</strong> Direct Costs and
appropriation/fund chargeable</td>
<td colspan="12"><strong>26a</strong> Immediate supervisor - <em>Name
and title</em></td>
<td colspan="18">Area code/Tel. No./Extension</td>
</tr>
<tr class="odd">
<td colspan="5"></td>
<td colspan="5">Amount</td>
<td colspan="9"></td>
<td colspan="11">YOUR SUPERVISOR</td>
<td colspan="19"></td>
</tr>
<tr class="even">
<td colspan="5">Item</td>
<td>Dollars</td>
<td colspan="4">Cents</td>
<td colspan="9">Appropriation/fund</td>
<td colspan="11">Title</td>
<td colspan="19">202/482-1234/    </td>
</tr>
<tr class="odd">
<td colspan="5"><strong>a.</strong> Tuition</td>
<td colspan="5">$995.00</td>
<td colspan="9"></td>
<td colspan="19"><strong>b.</strong> Signature</td>
<td colspan="11">Date</td>
</tr>
<tr class="even">
<td colspan="5"><strong>b.</strong> Books or materials</td>
<td colspan="5">$0.00</td>
<td colspan="9">custom to unit</td>
<td colspan="19"></td>
<td colspan="11"></td>
</tr>
<tr class="odd">
<td colspan="5"><strong>c.</strong> Other <em>(Specify)</em></td>
<td colspan="5"></td>
<td colspan="9">     </td>
<td colspan="12"><strong>27a.</strong> Second-line supervisor - <em>Name
and title</em></td>
<td colspan="18">Area code/Tel. No./Extension</td>
</tr>
<tr class="even">
<td colspan="5"></td>
<td colspan="5">$0.00</td>
<td colspan="9"></td>
<td colspan="11"><sup>2</sup>ND LEVEL SUPERVISOR</td>
<td colspan="19"></td>
</tr>
<tr class="odd">
<td colspan="3"><p><strong>d.</strong> (Enter 4 digits in</p>
<p>dollar column)</p></td>
<td colspan="2"><strong>12</strong></td>
<td colspan="5"></td>
<td colspan="9"></td>
<td colspan="12">Title</td>
<td colspan="18">202/482-1234/    </td>
</tr>
<tr class="even">
<td colspan="5"><strong>TOTAL</strong></td>
<td colspan="5">$995.00</td>
<td colspan="9"></td>
<td colspan="20"><strong>b.</strong> Signature</td>
<td colspan="10">Date</td>
</tr>
<tr class="odd">
<td colspan="19"><strong>22.</strong> Indirect costs and
appropriation/fund chargeble</td>
<td colspan="20"></td>
<td colspan="10"></td>
</tr>
<tr class="even">
<td colspan="5"></td>
<td colspan="5">Amount</td>
<td colspan="9"></td>
<td colspan="11"><strong>28a.</strong> Training officer - <em>Name and
title</em></td>
<td colspan="19">Area code/Tel. No./Extension</td>
</tr>
<tr class="odd">
<td colspan="5">Item</td>
<td>Dollars</td>
<td colspan="4">Cents</td>
<td colspan="9">Appropriation/fund</td>
<td colspan="11">Carol L. Davison</td>
<td colspan="19"></td>
</tr>
<tr class="even">
<td colspan="5"><strong>a.</strong> Travel</td>
<td colspan="5">$99.00</td>
<td colspan="9"></td>
<td colspan="12">Training Officer</td>
<td colspan="18">202/482-2537/    </td>
</tr>
<tr class="odd">
<td colspan="5"><strong>b.</strong> Per diem</td>
<td colspan="5">$55.00</td>
<td colspan="9">custom to unit</td>
<td colspan="18"><strong>b.</strong> Signature</td>
<td colspan="12">Date</td>
</tr>
<tr class="even">
<td colspan="5"><strong>c.</strong> Other <em>(Specify)</em></td>
<td colspan="5"></td>
<td colspan="9">     </td>
<td colspan="18"></td>
<td colspan="12"></td>
</tr>
<tr class="odd">
<td colspan="5"></td>
<td colspan="5">$0.00</td>
<td colspan="9"></td>
<td colspan="4"></td>
<td colspan="23"><strong>Section E-<span
class="smallcaps">APPROVAL/CONCURRENCE</span></strong></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="3"><p><strong>d.</strong> (Enter 4 digits in</p>
<p>dollar column)</p></td>
<td colspan="2"><strong>13</strong></td>
<td colspan="5"></td>
<td colspan="9"></td>
<td colspan="10"><strong>29a.</strong> Authorizing official - <em>Name
and title</em></td>
<td colspan="20">Area code/Tel. No./Extension</td>
</tr>
<tr class="odd">
<td colspan="5"><strong>TOTAL</strong></td>
<td colspan="5">$154.00</td>
<td colspan="9"></td>
<td colspan="10">Carol L. Davison</td>
<td colspan="20"></td>
</tr>
<tr class="even">
<td colspan="19"><strong>23.</strong> Document/Purchase
Order/Requisition No.</td>
<td colspan="10">Human Resources Specialis</td>
<td colspan="20">202/482-2537/    </td>
</tr>
<tr class="odd">
<td colspan="19">     </td>
<td colspan="10"><strong>b.</strong> Signature</td>
<td colspan="5"></td>
<td colspan="4">Approved</td>
<td colspan="11">Date</td>
</tr>
<tr class="even">
<td colspan="8"><strong>24.</strong> 8-Digit station symbol</td>
<td colspan="11"></td>
<td colspan="10"></td>
<td colspan="5"></td>
<td colspan="4">Disapproved</td>
<td colspan="11"></td>
</tr>
<tr class="odd">
<td colspan="8"><em>(Example -12-34-5678)</em></td>
<td colspan="11">130012/ITA</td>
<td colspan="3"></td>
<td colspan="26"><strong>Section F-CERTIFICATION OF TRAINING
COMPLETION</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="20"><strong>25. BILLING INSTRUCTIONS</strong> <em>(Furnish
invoice to:)</em></td>
<td colspan="11"><strong>30a.</strong> Certifying official - <em>Name
and title</em></td>
<td colspan="18">Area code/Tel. No./Extension</td>
</tr>
<tr class="odd">
<td colspan="20">N/A</td>
<td colspan="11">     </td>
<td colspan="18"></td>
</tr>
<tr class="even">
<td colspan="20">     </td>
<td colspan="11">     </td>
<td colspan="18">   /   -    /    </td>
</tr>
<tr class="odd">
<td colspan="20">     </td>
<td colspan="18"><strong>b.</strong> Signature</td>
<td colspan="11">Date</td>
</tr>
<tr class="even">
<td colspan="20"></td>
<td colspan="18"></td>
<td colspan="11"></td>
</tr>
<tr class="odd">
<td colspan="49"><strong>TRAINING FACILITY</strong> <strong>Bills should
be sent to office indicated in item 25. Please refer to number given in
item 23 to assure prompt payment.</strong></td>
</tr>
</tbody>
</table>

+-----------------------------------+----------------------------------+
| > **NOTE:** This agreement must   |                                  |
| > be signed by the nominee for    |                                  |
| > all **non-government** training |                                  |
| > that exceeds 80 hours (or such  |                                  |
| > other designated period, 80     |                                  |
| > hours or less, as prescribed by |                                  |
| > the agency) and for which the   |                                  |
| > Government approves payment of  |                                  |
| > training costs prior to the     |                                  |
| > commencement of such training.  |                                  |
| > Nothing contained in Section G  |                                  |
| > below shall be construed as     |                                  |
| > limiting the authority of an    |                                  |
| > agency to waive, **in whole or  |                                  |
| > in part**, an obligation of an  |                                  |
| > employee to pay expenses        |                                  |
| > incurred by the Government in   |                                  |
| > connection with the training.   |                                  |
+-----------------------------------+----------------------------------+
| > **Section G EMPLOYEE'S          |                                  |
| > AGREEMENT TO CONTINUE IN        |                                  |
| > SERVICE**                       |                                  |
|                                   |                                  |
| 1.  I AGREE that, upon completion |                                  |
|     of the Government-sponsored   |                                  |
|     training described in this    |                                  |
|     request, if I receive salary  |                                  |
|     covering the training period, |                                  |
|     I will serve in the agency    |                                  |
|     three times the length of the |                                  |
|     training period. If I receive |                                  |
|     no salary during the training |                                  |
|     period, I agree to service    |                                  |
|     the agency for a period equal |                                  |
|     to the length of training,    |                                  |
|     but in no case less than one  |                                  |
|     month. (The length of         |                                  |
|     part-time training is the     |                                  |
|     number of hours spent in      |                                  |
|     class or with the instructor. |                                  |
|     The length of full-time       |                                  |
|     training is eight hours for   |                                  |
|     each day of training, up to a |                                  |
|     maximum of 40 hours a week).  |                                  |
|     NOTE: For the purposes of     |                                  |
|     this agreement, the term      |                                  |
|     "agency" refers to the        |                                  |
|     employing organization (such  |                                  |
|     as an Executive Department or |                                  |
|     independent establishment,    |                                  |
|     not to a segment of such an   |                                  |
|     organization.                 |                                  |
|                                   |                                  |
| 2.  If I voluntarily leave the    |                                  |
|     agency before completing the  |                                  |
|     period of service agreed to   |                                  |
|     in item 1 above, I AGREE to   |                                  |
|     reimburse the agency for the  |                                  |
|     tuition and related fees,     |                                  |
|     travel and other special      |                                  |
|     expenses (EXCLUDING SALARY)   |                                  |
|     paid in connection with my    |                                  |
|     training. These amounts are   |                                  |
|     reflected in items 21 and 22. |                                  |
|                                   |                                  |
| 3.  I FURTHER AGREE, that if I    |                                  |
|     voluntarily leave the agency  |                                  |
|     to enter the service of       |                                  |
|     another Federal agency or     |                                  |
|     other organization in any     |                                  |
|     branch of the Government      |                                  |
|     before completing the period  |                                  |
|     of service agreed to in item  |                                  |
|     1 above, I will give my       |                                  |
|     organization written notice   |                                  |
|     of at least ten work days,    |                                  |
|     during which time a           |                                  |
|     determination concerning      |                                  |
|     reimbursement will be made.   |                                  |
|     If I fail to give this        |                                  |
|     advance notice, I AGREE to    |                                  |
|     pay the amount of additional  |                                  |
|     expenses (5 U.S.C.            |                                  |
|     4109(a)(2)) incurred by the   |                                  |
|     Government in this training.  |                                  |
|                                   |                                  |
| 4.  I understand that any amounts |                                  |
|     which may be due the agency   |                                  |
|     as a result of any failure on |                                  |
|     my part to meet the terms of  |                                  |
|     this agreement may be         |                                  |
|     withheld from any monies      |                                  |
|     owned me by the Government,   |                                  |
|     or may be recovered by such   |                                  |
|     other methods as are approved |                                  |
|     by law.                       |                                  |
|                                   |                                  |
| 5.  I FURTHER AGREE to obtain     |                                  |
|     approval from my organization |                                  |
|     training officer and that     |                                  |
|     person responsible for        |                                  |
|     authorizing non-government    |                                  |
|     training requests of any      |                                  |
|     proposed change in my         |                                  |
|     approved training program     |                                  |
|     involving course and schedule |                                  |
|     changes, withdrawals or       |                                  |
|     incompletions, and increased  |                                  |
|     costs.                        |                                  |
|                                   |                                  |
| 6.  I acknowledge that this       |                                  |
|     agreement does not in any way |                                  |
|     commit the Government to      |                                  |
|     continue my employment. I     |                                  |
|     understand that, if there is  |                                  |
|     a transfer of my service      |                                  |
|     obligation to another Federal |                                  |
|     agency or other organization  |                                  |
|     in any branch of the          |                                  |
|     Government, the agreements in |                                  |
|     items 1, 2, and 3 of this     |                                  |
|     section will remain in effect |                                  |
|     until I have completed my     |                                  |
|     obligated service with that   |                                  |
|     other agency or organization. |                                  |
+-----------------------------------+----------------------------------+
| **31.** Period of obligated       |                                  |
| service                           |                                  |
|                                   |                                  |
| > ***(For non-government training |                                  |
| > only)***                        |                                  |
+-----------------------------------+----------------------------------+
| **32.** Employee's signature      | Date                             |
+-----------------------------------+----------------------------------+
|                                   |                                  |
+-----------------------------------+----------------------------------+

+-------------------------------+-----+-------------------------------+
| **PRIVACY ACT STATEMENT**     |     |                               |
+-------------------------------+-----+-------------------------------+
| **General** This information  |     | **Information Regarding       |
| is provided pursuant to       |     | Disclosure of Your Social     |
| Public Law\                   |     | Security Number Under Public  |
| 93-579 (Privacy Act of 1974), |     | Law 93-579, Section 7(b)**    |
| December 31, 1974, for        |     | Disclosure by you of your     |
| indi-viduals completing       |     | Social Security Number (SSN)  |
| Federal nomination for        |     | is mandatory to obtain the    |
| training forms.               |     | training you are seeking.     |
|                               |     | Solicitation of the SSN by    |
| **Authority** The Government  |     | the Office of Personnel       |
| Employees Training Act of     |     | Management is authorized      |
| 1958 (U.S. Code, Title 5,     |     | under provisions of Executive |
| sections 4101 to 4118).       |     | Order 9397, dated November    |
|                               |     | 22, 1943. The SSN is used as  |
| **Purposes and Uses** The     |     | an identifier to match the    |
| information on this form is   |     | person completing the         |
| used in the administration of |     | training with the correct     |
| the Federal Training Program. |     | master record in the Central  |
| The pur-pose of this form is  |     | Personnel Data File (CPDF).   |
| to document the nomination of |     | It will be used primarily to  |
| trainees and completion of    |     | give you recognition for      |
| training; and it serves as    |     | completing the training and   |
| the principal repository of   |     | to accumulate government-wide |
| personal, fiscal and          |     | training statistical          |
| administrative information    |     | information. The information  |
| about trainees and the        |     | gathered through the use of   |
| programs in which they        |     | the number will be used only  |
| participate. The form becomes |     | as necessary in training      |
| a part of the permanent       |     | administration processes      |
| employment record of          |     | carried out in accordance     |
| participants in training      |     | with established regulations. |
| programs and is included in   |     | The SSN also will be used for |
| the Government's Central      |     | the selection of persons to   |
| Personnel Data File.          |     | be included in statistical    |
|                               |     | studies of training           |
| **Effects of Nondisclosure**  |     | management matters. The use   |
| Personal information provided |     | of the SSN is made necessary  |
| on this form is given on a    |     | because of the large number   |
| voluntary basis as is         |     | of present Federal employees  |
| participation in any training |     | who have identical names and  |
| program. Failure to provide   |     | birth dates, and whose        |
| this information, however,    |     | identities can only be        |
| may result in ineligibility   |     | distinguished by the SSN.     |
| for participation in training |     |                               |
| programs.                     |     |                               |
+-------------------------------+-----+-------------------------------+

+-----------------------------------------------------------------------+
| > **GENERAL INSTRUCTIONS** Prepare this request in accordance with    |
| > instructions included on form and indicated below. Complete         |
| > Sections A, B, C, D26, D27, and G32 (reverse of copy 1) and submit  |
| > to appropriate Agency Training Office within the specified lead     |
| > time for processing. Copy 10 is for your files.                     |
+-----------------------------------------------------------------------+
| **SPECIFIC INSTRUCTIONS**                                             |
+-----------------------------------------------------------------------+

**Section A TRAINEE INFORMATION**

> **Item 1** After filling in the trainee's full name, enter the first
> five letters of the last name in the shaded box.
>
> **Item 2** Use 9 digits for the Social Security Number.
>
> **Item 3** Enter year and month of birth (e.g., if the trainee's birth
> date\
> is January 14, 1943, it would appear as 43/01).
>
> **Item 4 - 8** Self-explanatory/follow agency instructions.
>
> **Item 9** Enter number of years and months of continuous civilian
> Gov-ernment service.
>
> **Item 10** To be filled in by nominating Agency Training Office.
>
> **Item 11a.** Self-explanatory. (If additional space is necessary to
> de-scribe duties and responsibilities, attach separate sheet.)
>
> **Item 11b.** If the applicant is disabled or handicapped and in need
> of special arrangements (Brailling, taping, interpreters, facility
> accessibil-\
> ity, etc.) describe the special arrangements on a separate sheet and
> attach to the Vendor Copy (copy 3). NOTE: The applicant is not
> required to furnish this information. His/her signature on the
> descriptive sheet indicates agreement to release it to training
> vendors.
>
> **Item 12** Self-explanatory.
>
> **Item 13** Career Conditional (C.C.), Career (C), Temporary (Temp.),
> etc.
>
> **Item 14** Follow agency instructions.

**Section B TRAINING COURSE DATA**

> **Items 15 - 17** Self-explanatory. (Item 16 if additional space is
> neces-sary, attach separate sheet.)
>
> **Item 18** Enter the year, month, and day the course begins and ends\
> (e.g., a course starting June 15, 1973, and ending December 15, 1973,
> would be entered as 73/06/15 and 73/12/15).
>
> **Item 19** The number of course hours can be determined by multiply-\
> ing the number of hours attended per week by the number of weeks of
> the course or semester.
>
> **Item 20** Select an appropriate code for each item listed below and
> enter in code boxes on form.

**Section C ESTIMATE COSTS AND BILLING INFORMATION**

> **Item 21, 22** Follow agency instructions.
>
> **Item 23** Enter Document/Purchase Order/Requisition Number for
> reimbursement of training costs to responsible Training Vendor. This
> number is to be referenced on the billing document.
>
> **Item 24** Fill in 8-digit station symbol of the nominating agency
> finance office which will report the payment on SF-224, Statement of
> Transac-\
> tions. If a nominating agency does not report on SF-224 and will issue
> a check, type "SF-1080" in this block.
>
> **Item 25** Enter name and mailing address of nominating Agency
> Fi-nance Office for billing purposes.

**Section C and D TERMINATION AND EVALUATION DATE** **Copy 9**

> This information will be filled in on copy 9 after training is
> completed (follow agency instructions

**Section D APPROVALS**

> **Items 26, 27** To be completed by applicant's immediate and/or
> second-line supervisor(s) before submission of form to nominating
> Agency Training Office as indicated in agency instructions.
>
> **Items 28** To be completed by the nominating Agency Training
> Officer.

**Section E APPROVAL/CONCURRENCE**

> **Item 29** To be completed by the nominating Agency Official who is
> authorized to approve or disapprove request.
>
> **NOTE:** Approving officials may authorize training in non-government
> facilities only after determining that adequate training is not
> reasonably available within Government.

**Section F CERTIFICATION OF TRAINING COMPLETION**

> **Item 30** To be completed by nominating Agency Certifying Official.

**Section G EMPLOYEE'S AGREEMENT TO CONTINUE IN SERVICE (NON-GOVERNMENT
TRAINING) Copy 1 Reverse side**

> The applicant must read and understand the statements contained in the
> agreement. If there are any questions concerning this section, please
> contact the nominating Agency Training Office.
>
> **Item 31** To be completed by nominating Training Office.
>
> **Item 32** To be signed and dated by employee nominated for
> non-gov-ernment Training.

**Section G FINANCE Copy 7 only**

> **Item 31, 32** To be filled in by the nominating Agency Finance
> Office.

**Section H TRAINING VENDOR Copies 5 and 6 only**

> Instructions on reverse of copy 3.

**Section I**

> **Copy 5** Mailing Address of nominating Agency.
>
> **Copy 6** Mailing address of employee.
>
> To be filled in by nominating Agency Training Office. Name and address
> to be stamped on copy 5.

+-----------------------+-----------------------+----------------------+
| **CODES FOR ITEM 20   |                       |                      |
| (See 1-part form for  |                       |                      |
| code definitions)**   |                       |                      |
+-----------------------+-----------------------+----------------------+
| **A. Purpose**        | **B. Type**           | **C. Source**        |
+-----------------------+-----------------------+----------------------+
| 1.  Mission or        | 1.  Executive and     | 1.  Government       |
|     program change    |     Management        |     Agency           |
|                       |                       |                      |
| 2.  New technology    | 2.  Supervisory       | 2.  Government       |
|                       |                       |     Interagency      |
| 3.  New work          | 3.  Legal, Medical,   |                      |
|     assignment        |     Scientific,\      | 3.  Non-government   |
|                       |     or Engineering    |     Designed for     |
| 4.  Improve present   |                       |     agency           |
|     performance       | 4.  Administration    |                      |
|                       |     and analysis      | 4.  Non-government   |
| 5.  Meet future       |                       |     Off-shelf        |
|     staffing needs    | 5.  Specialty and     |                      |
|                       |     Technical         | 5.  State or local   |
| 6.  Develop           |                       |     government       |
|     unavailable       | 6.  Clerical          |                      |
|     skills            |                       | **D. SPECIAL         |
|                       | 7.  Trade or craft    | INTEREST**           |
| 7.  Trade or craft    |                       |                      |
|     apprenticeship    | 8.  Orientation       | 1.  No special       |
|                       |                       |     program          |
| 8.  Orientation       | 9.  Adult basic       |                      |
|                       |     education         | 2.  Executive        |
| 9.  Adult basic       |                       |     development      |
|     education         |                       |                      |
|                       |                       | 3.  Supervision\     |
|                       |                       |     (Other codes may |
|                       |                       |     be developed\    |
|                       |                       |     follow agency    |
|                       |                       |     instructions)    |
+-----------------------+-----------------------+----------------------+