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**NASS CAREER INTERN PROGRAM**

**Position Titles/Series/Grades:** Survey Statistician
(Agriculture)/Statistician (Agriculture) GS-1530-5/7/9

Mathematical Statistician GS-1529-9

IT Specialist, GS-2210-5/7/9

**Promotion Potential:** GS-12

The Career Intern Program (CIP) is designed to attract qualified college
graduates who have an interest in a career in public service with the
National Agricultural Statistics Service (NASS).

Individuals are appointed to a two-year internship in the excepted
service. Throughout the internship, employees participate in formal
training, are assigned a mentor, and receive job assignments to develop
appropriate competencies. Upon successful completion of the program,
interns are eligible for noncompetitive conversion to a
career-conditional appointment to positions for which they are eligible
and qualified.

**Location of Position:** Positions may be filled in any of the 46 Field
Offices, including the Puerto Rico Field Office, and in Washington, D.C.
Persons selected for positions in the NASS may be appointed in a
location other than their current State of residence or commonwealth,
and may be reassigned to other Field Offices and to Washington, D.C.

**Area of Consideration:** This program is open to all United States
Citizens, issued under an excepted service authority from the Office of
Personnel Management.

In rare and unusual circumstances an appointment may be extended an
additional 120 days beyond the two years. Request for extensions must be
in writing and approved by the ARS/AFM/HRD/MSB Team Leader servicing the
geographical location where the intern is currently employed. The
written request must clearly state the reason(s) for the extension.

For more information regarding Career Intern opportunities with NASS
contact:

USDA/NASS

Field Operations, Human Resources

Room 5058 -- South Building

1400 Independence Avenue, S.W.

Washington, D.C. 20250-2000

Telephone: (800) 832-4180

OR

Recruitment Announcement:
<http://www.nass.usda.gov/Contact_Us/Opportunities/index.asp>

**POSITIONS TO BE FILLED**

The primary positions filled through this program is that of a Survey
Statistician (Agriculture)/Statistician (Agriculture). The agriculture
specialization is the main source of recruitment under this program;
however, two other specializations are also covered by this program: IT
Specialist and Mathematical Statistician. **Applicants who qualify for
the Survey Statistician (Agriculture)/Statistician (Agriculture) and IT
Specialist will be rated eligible at the GS-5, GS-7, or GS-9 levels.
Those who qualify for the Mathematical Statistician will be rated at the
GS-9 level only.** Applicants who qualify for any of the two secondary
specializations will have the same promotional opportunities as those
applicants who qualify for the agriculture specialization. (See
"Promotional Opportunities" below).

**SPECIAL NOTE: Applicants who are rated eligible as a Survey
Statistician (Agriculture)/Statistician (Agriculture) will be rated
ineligible for any other specialization unless there is evidence that
the applicant is eligible at a higher grade level in any one of the
other two job specialties.**

**SURVEY STATISTICIANS (AGRICULTURE)/STATISTICIANS (AGRICULTURE)** apply
statistical theory and techniques to the survey planning, organization
and operation of programs for collecting, verifying, adjusting,
processing, summarizing, analyzing and presenting information expressed
numerically. This specialization includes positions in which the primary
concern is the planning or execution of the census of agriculture and
complete surveys of any size, including the establishment of general
specifications and detail time schedules governing the various steps
involved in data collection, processing, and publication. They may
translate general processing specifications established by survey
planners into detailed and practical plans for data processing systems;
design systems to control incoming data collection materials; develop
scheduling and data management procedures; and programming for a variety
of tabulation methods and summarization of data. They prepare estimates
relating to acreages, production of farm crops, number of livestock on
farms, livestock products, stocks of agricultural commodities, value and
utilization of farm products, prices received and paid by farmers, and
other aspects of the agricultural economy.

**MATHEMATICAL STATISTICIANS** work in the development and adaptation of
mathematical statistical theory and methodology for a wide variety of
statistical investigations. They are responsible for research and
evaluation of the applicability, efficiency, and accuracy of the theory
and various statistical programs and studies. Positions covered by this
announcement apply this theory and knowledge to censuses and
agricultural survey activities.

**INFORMATION TECHNOLOGY SPECIALISTS** translate general processing
specifications established by survey planners into detailed and
practical plans for data processing systems; design of systems to
control incoming data collection materials; development of scheduling
and data management procedures; and programming for a variety of
tabulation methods and summarization of data.

**PROMOTIONAL OPPORTUNITIES**

Survey Statisticians (Agriculture)/Statisticians (Agriculture) and IT
Specialists who are appointed at the GS-5 level may be promoted to the
GS-7 level after satisfactorily completing a 12-month training period.
Further advancement opportunities occur as the Survey Statistician
(Agriculture)/Statistician (Agriculture) and IT Specialist meets the
qualification requirements and demonstrates the ability to perform at
the higher level duties.

Mathematical Statisticians appointed at the GS-9 level may be promoted
to the GS-12 level after satisfactorily completing training and meeting
the agricultural and statistics requirements as developed in an
Individual Development Plan (IDP). Training courses, often at Government
expense, are available in job-related subjects.

**QUALIFICATION REQUIREMENTS**

To qualify for a **Survey Statistician (Agriculture)/Statistician
(Agriculture)** position, each applicant must meet the following
requirements:

**GS-5:** Attainment of a Bachelor's degree, or equivalent education and
experience, including the following course work:

1\. At least 15 semester hours in mathematics and/or statistics, of
which at least 6 semester hours are in statistics; **AND**

2\. At least 9 semester hours in other physical or social sciences (it
is desirable that these be in the agricultural sciences, such as
agronomy, livestock husbandry, agricultural business management,
agricultural economics, agricultural education or farm management;
computer science and/or survey techniques and methodologies).

**GS-7:** Completion of all requirements for GS-5, **plus\--**

> 1\. One year of full-time graduate education in agricultural sciences,
> statistical methodologies, data processing techniques, or survey
> techniques; **OR**
>
> 2\. One year of specialized experience in a related area comparable to
> the GS-5 level of difficulty in the Federal Service; **OR**

3\. Combination of appropriate specialized experience and graduate
education totaling one year; **OR**

> 4\. Attainment of superior academic achievement in undergraduate
> studies, based on demonstration of one of the following:

a\. A 3.0 grade-point average on a 4.0 scale for all courses completed
at the time of application; or during the last 2 years of the
undergraduate curriculum; **OR**

> b\. A 3.5 grade-point average in the major field of study at the time
> of application, or during the last 2 years of the undergraduate
> curriculum; **OR**

c\. A standing in the upper third of the college class or major
subdivision; **OR**

> d\. Election to membership in one of the national honorary societies
> (other than freshman or sophomore societies) recognized by the
> Association of College Honor Societies.

**GS-9:** Completion of all requirements for GS-5, **plus\--**

> 1\. Two full academic years of graduate education in agricultural
> sciences; **OR**

2\. A Master's degree in agricultural sciences; **OR**

3\. One year of agricultural statistics specialized experience
comparable to the GS-7 level of difficulty in the Federal Service;
**OR**

4\. A combination of appropriate specialized experience and graduate
education totaling one year.

To qualify for a **Mathematical Statistician GS-9** position, each
applicant must satisfactorily complete the following:

**Basic Requirement:**

1\. Degree: that included 24 semester hours of mathematics and
statistics, of which at least 12 semester hours were in mathematics and
6 semester hours were in statistics; **OR**

2\. Combination of education and experience--at least 24 semester hours
of mathematics and statistics, including at least 12 hours in
mathematics and 6 hours in statistics, as shown in 1 above, plus
appropriate experience or additional education.

**QUALIFICATION REQUIREMENTS (Continued):**

**Evaluation of Education:** Courses acceptable toward meeting the
mathematics course requirement of paragraphs 1 or 2 above must have
included at least four of the following: differential calculus, integral
calculus, advanced calculus, theory of equations, vector analysis,
advanced algebra, linear algebra, mathematical logic, differential
equations, or any other advanced course in mathematics for which one of
these was a prerequisite. Courses in

mathematical statistics or probability theory with a prerequisite of
elementary calculus or more advanced courses will be accepted toward
meeting the mathematics requirements, with the provision that the same
course cannot be counted toward both the mathematics and the statistics
requirement.

**Evaluation of Experience:** The experience offered in combination with
educational courses to meet the requirements in the paragraph above
should include evidence of statistical work such as (a) sampling, (b)
collecting, computing, and analyzing statistical data, and (c) applying
known statistical techniques to data such as measurement of central
tendency, dispersion, skewness, sampling error, simple and multiple
correlation, analysis of variance, and tests of significance.

Without other indications of statistical experience, work required in
the processing of numerical or quantified information by other than
statistical methods is not considered appropriate qualifying experience.
Examples of non-qualifying work include statistical clerical work;
statistical drafting; calculation of totals, averages, percentages, or
other arithmetic summations; preparation of simple tables or charts; or
verification of data by simple comparison or proofreading.

In addition to meeting the Basic Requirements, applicants must have
specialized experience and/or directly related education in the amounts
shown below.

3\. Two full academic years of graduate education; **OR**

4\. A Master's Degree in mathematics and statistics which meets the
requirements listed in Item 1 above; **OR**

5\. One year of specialized experience in mathematical statistics
research and/or analytical type work comparable to the GS-7 level of
difficulty in the Federal Service; **OR**

6\. A combination of successfully completed graduate level education and
specialized experience may be used to meet total experience
requirements. Only graduate level education in excess of the amount
required for the next lower grade level may be combined with experience.
For example, an applicant with 6 months of appropriate experience
equivalent to GS-7 (50 percent of the experience requirement for GS-9)
and 27 semester hours of appropriate graduate education (50 percent of
the education requirement for GS-9, in excess of that required for GS-7)
would be qualified for a GS-9 position (assuming that there is no
evidence that the attended college or university requires more than 18
semester hours as equivalent to a year of graduate study).

To qualify for an **Information Technology Specialist** position, each
applicant must meet the following requirements:

**GS-5:** Attainment of a Bachelor's degree or better in the following
major study:

1.  Computer science, information science, information systems
    management, mathematics, statistics, operations research, or
    engineering; **OR**

2.  Equivalent experience and education including course work that
    required the development or adaptation of computer programs and
    systems and provided knowledge equivalent to a major in the computer
    field.

    **GS-7:** Completion of all requirements for GS-5, **plus**

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1.  One year of full-time graduate education in computer science,
    information science, information systems management, mathematics,
    statistics, operations research, or engineering; **OR**

2.  One year of professional experience in a related area comparable to
    the GS-5 level of difficulty in the Federal Service; **OR**

3.  Combination of appropriate professional experience and graduate
    education totaling one year; **OR**

**QUALIFICATION REQUIREMENTS (Continued):**

4.  Attainment of superior academic achievement in undergraduate
    studies, based on the demonstration of one of the following:

    A.  A 3.0 grade-point average on a 4.0 scale for all courses
        completed at the time of application; or during the last 2 years
        of the undergraduate curriculum; **OR**

    B.  A 3.5 grade-point average in the major field of study at the
        time of application, or during the last 2 years of the
        undergraduate curriculum; **OR**

    C.  A standing in the upper third of the college class or major
        subdivision; **OR**

    D.  Election to membership in one of the national honorary societies
        (other than freshman or sophomore societies) recognized by the
        Association of College Honor Societies.

        **GS-9:** Completion of all requirements for GS-7, **plus**

```{=html}
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```
1.  Two full years of graduate education in computer science,
    information science, information systems management, mathematics,
    statistics, operations research, or engineering; **OR**

2.  A Master's degree in computer science, information science,
    information systems management, mathematics, statistics, operations
    research, or engineering; **OR**

3.  One year of professional experience comparable to the GS-7 level of
    difficulty in the Federal Service that demonstrated knowledge of
    computer requirements and techniques in carrying out project
    assignments consisting of several related tasks, such as typically
    is the case in development of minor modifications to parts of a
    system on the basis of details specifications provided. This
    involves the analysis of the interrelationships of pertinent
    components of the systems; planning the sequence of actions
    necessary to accomplish the assignment; and personal responsibility
    for at least a segment of the overall project, or the equivalent;
    **OR**

4.  A combination of appropriate professional experience and graduate
    education totaling one year.

    **OTHER CREDITING EXPERIENCE**

    Credit will be given for unpaid, directly-related experience or
    volunteer work, such as community, cultural, social service, and
    professional association activities on the same basis as for paid
    experience. To receive proper credit, you must provide the duties
    performed and the number of hours per week that was spent in such
    activities.

    **FILING PRIOR TO GRADUATION**

    If you are a senior or a graduate student, you may file prior to
    completing all the scholastic requirements if you expect to complete
    such requirements within 6 months of the date you file. You should
    submit a list of titles and credit hours of courses which you expect
    to complete within the period. You may be offered an appointment but
    may not enter on duty until (1) successful completion of all the
    required study and (2) your official transcript or other acceptable
    documentation have been received by the employment office.

    **APPLICATION INFORMATION**

Send a Resume **OR** OF-612 (Optional Application for Federal
Employment) <http://www.opm.gov/forms/pdf_fill/of612.pdf>, Certified
Copy of College Transcripts,

USDA Career Intern Application, and Geographic Availability Form to:

**Regular Mail:**

USDA/NASS

South Building -- Room 5058

1400 Independence Avenue, S.W.

Washington, D.C. 20250

(Applications submitted via Government envelopes **[will not be
accepted]{.underline}**.)

FAX: (202) 720-3131

E-MAIL: <HQ_DAFO_HRS@nass.usda.gov>

**VETERANS\' PREFERENCE**

If applicants served on active duty in the United States military and
were separated under honorable conditions, they may be eligible for
Veterans\' preference. To claim 5-point Veterans' preference, applicants
must attach a copy of their DD-214, Certificate of Release or Discharge
from Active Duty, or other proof of eligibility. To claim 10-point
Veterans' preference, attach an SF-15, Application for 10-Point Veterans
Preference, plus the documentation required by that form. For further
details, call the U.S. Office of Personnel Management (OPM) at (912)
757-3000. Select "Federal Employment Topics"and then "Veterans." Or,
dial OPM's electronic bulletin board at (912) 757-3100 or visit their
Vet Guide web site:
[**www.opm.gov/employ/html/vetguide.html.**](http://www.opm.gov/employ/html/vetguide.html.)

**EEO STATEMENT**

The U.S. Department of Agriculture (USDA) prohibits discrimination in
all its programs and activities on the basis of race, color, national
origin, gender, religion, age, disability, political beliefs, sexual
orientation, and marital or family status. (Not all prohibited bases
apply to all programs.) Persons with disabilities who require
alternative means for communication of program information (Braille,
large print, audiotape, etc.) should contact USDA\'s TARGET Center at
(202) 720-2600 (voice or TDD).

To file a complaint of discrimination, write USDA, Director, Office of
Civil Rights, Room 326-W, Jamie L. Whitten Federal Building, 1400
Independence Avenue, S.W., Washington, D.C. 20250-9410 or call (202)
720-5964 (voice or TDD). **USDA is an equal opportunity provider and
employer.**

**ACCOMMODATIONS**

This agency provides reasonable accommodations to applicants with
disabilities where appropriate. If you need a reasonable accommodation
for any part of the application and hiring process or have questions
regarding reasonable accommodation and/or accessibility for any part of
the application and hiring process, please contact the Disability
Program Manager on (202) 720-6161 or through the DC Relay Service on
(202) 855-1234 (TDD). The decision on granting reasonable accommodation
will be on a case-by-case basis.

**If applications do not contain all of the requested information,
applicants may lose consideration for the job.**

**If applicants make a false statement in any part of their application,
they may not be hired, may be fired after they begin work, or may be
fined or jailed.**

![](media/image4.wmf){width="1.1263888888888889in" height="0.8125in"}

**APPLICATION**

**U.S. Department of Agriculture Career Intern Program**

**Career
Field\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Name (last, first, middle):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Social Security Number:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Temporary Mailing
Address:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**City: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
State: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Zip Code:
\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Permanent
Mailing:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**City: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
State: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Zip Code:
\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Temporary Phone Number: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Permanent Phone Number:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Cell Phone Number:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Email:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
U.S. Citizen: ☐ YES ☐ NO**

**Veterans Preference: ☐ None ☐ 5-point ☐ 10-point disability ☐ 10-point
compensable**

**☐ 10-point other ☐ 10- point compensable/30percent**

**(Attach DD-214 Application for 10-Point Veteran's Preference (SF-15),
or Department of Defense or Department of Veterans Affairs
documentation, as appropriate).**

**Birth Date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Birthplace:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**(Month, Day, Year) (City and State or County)**

**School:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Grade Point Average \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (MUST BE WITHIN 6
MONTHS OF APPLICATION DATE)**

**Date of Graduation: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Major/Graduate**

**Program:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Community Service:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Awards:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Leadership Examples:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**I certify that, to the best of my knowledge and belief, all of the
information I have provided in this application is made in good faith. I
consent to the release of information from schools, employers, and other
individuals and organizations about my ability and fitness for Federal
employment.**

**SIGNATURE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**PRINTED NAME:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**PLEASE ATTACH YOUR RESUME' TO THIS APPLICATION**

+-----------------+-----------------+----------------+-------------+---+
| **NAME (Last,   |                 |                |             |   |
| First,          |                 |                |             |   |
| Middle)**       |                 |                |             |   |
+-----------------+-----------------+----------------+-------------+---+
| **Geographic    |                 |                |             |   |
| Availability:** |                 |                |             |   |
|                 |                 |                |             |   |
| Indicate below  |                 |                |             |   |
| the locations   |                 |                |             |   |
| in which you    |                 |                |             |   |
| prefer to work. |                 |                |             |   |
| If you wish to  |                 |                |             |   |
| receive         |                 |                |             |   |
| consideration   |                 |                |             |   |
| for all         |                 |                |             |   |
| locations       |                 |                |             |   |
| listed, check   |                 |                |             |   |
| box for         |                 |                |             |   |
| "Anywhere."     |                 |                |             |   |
+-----------------+-----------------+----------------+-------------+---+
| ☐ **ALABAMA**   | ☐ **INDIANA**   | ☐ **NEBRASKA** | ☐           |   |
|                 |                 |                | **PEN       |   |
| > Sterling      | 1435 Win        | > Room 298,    | NSYLVANIA** |   |
| > Center, Suite | Hentschel Blvd. | > Federal      |             |   |
| > 200           |                 | > Bldg.        | > 2301 N.   |   |
| >               | Suite 110       | >              | > Cameron   |   |
| > 4121          |                 | > 100          | > Street    |   |
| > Carmichael    | W. Lafayette    | > Centennial   | >           |   |
| > Road          | 47906-4145      | > Mall North   | > Room G-19 |   |
| >               |                 | >              | >           |   |
| > Montgomery    | 1-800-363-0469  | > Lincoln      | >           |   |
| > 36106-2872    |                 | > 68508        |  Harrisburg |   |
| >               |                 | >              | > 17110     |   |
| >               |                 | >              | >           |   |
|  1-800-832-4181 |                 | 1-800-582-6443 | > 1-8       |   |
|                 |                 |                | 00-498-1518 |   |
+-----------------+-----------------+----------------+-------------+---+
| ☐ **ALASKA**    | ☐ **IOWA**      | ☐ **NEVADA**   | ☐ **SOUTH   |   |
|                 |                 |                | CAROLINA**  |   |
| > 1150 S.       | 833 Federal     | > Nevada Ag    |             |   |
| > Colony Way    | Building        | > Statistics   | > 1835      |   |
| >               |                 | > Service      | > Assembly  |   |
| > Suite 11      | 210 Walnut      | >              | > Street    |   |
| >               | Street          | > 5600 Fox     | >           |   |
| > Palmer 99645  |                 | > Avenue       | > Room 1008 |   |
| >               | Des Moines      | >              | >           |   |
| >               | 50309           | > Room 113     | > Columbia  |   |
|  1-800-478-6079 |                 | >              | > 29201     |   |
|                 | 1-800-772-0825  | > Reno         | >           |   |
|                 |                 | > 89506-1300   | > 1-8       |   |
|                 |                 |                | 00-424-9406 |   |
|                 |                 | 1-888-456-7211 |             |   |
+-----------------+-----------------+----------------+-------------+---+
| ☐ **ARIZONA**   | ☐ **KANSAS**    | ☐ **NEW        | ☐ **SOUTH   |   |
|                 |                 | H              | DAKOTA**    |   |
| > 230 N First   | 632 SW. Van     | AMPSHIRE\*\*** |             |   |
| > Avenue        | Buren           |                | > 5020 S.   |   |
| >               |                 | > 53 Pleasant  | > Broadband |   |
| > Suite 303     | Room 200        | > Street       | > Lane      |   |
| >               |                 | >              | >           |   |
| > Phoenix       | Topeka 66603    | > Room 2100    | > Sioux     |   |
| > 85003-1706    |                 | >              | > Falls     |   |
|                 | 1-800-258-4564  | > Concord      | > 57108     |   |
| 1-800-645-7286  |                 | > 03301        | >           |   |
|                 |                 | >              | > 1-8       |   |
|                 |                 | >              | 00-338-2557 |   |
|                 |                 | 1-800-642-9571 |             |   |
+-----------------+-----------------+----------------+-------------+---+
| ☐ **ARKANSAS**  | ☐ **KENTUCKY**  | ☐ **NEW        | ☐           |   |
|                 |                 | JERSEY**       | **          |   |
| > 10800         | Gene Snyder     |                | TENNESSEE** |   |
| > Financial     | Courthouse      | > Health &     |             |   |
| > Centre Pkwy.  | Building        | > Agriculture  | > Holeman   |   |
| >               |                 | > Blvd.        | > Office    |   |
| > Suite 110     | 601 W.          | >              | > Building  |   |
| >               | Broadway, Rm.   | > 369 South    | >           |   |
| > Little Rock   | 645             | > Warren       | > 440 Hogan |   |
| > 72211         |                 | > Street       | > Road      |   |
| >               | Louisville      |                | >           |   |
| >               | 40202           | Room 205       | > Nashville |   |
|  1-800-327-2970 |                 |                | >           |   |
|                 | 1-800-928-5277  | > Trenton      |  37720-1626 |   |
|                 |                 | > 08625        | >           |   |
|                 |                 | >              | > 1-8       |   |
|                 |                 | >              | 00-626-0987 |   |
|                 |                 | 1-800-328-0179 |             |   |
+-----------------+-----------------+----------------+-------------+---+
| ☐               | ☐ **LOUISIANA** | ☐ **NEW        | ☐ **TEXAS** |   |
| **CALIFORNIA**  |                 | MEXICO**       |             |   |
|                 | 5825 Florida    |                | > Federal   |   |
| > 650 Capitol   | Blvd.           | > 2507 North   | > Building  |   |
| > Mall, Suite   |                 | > Telshor      | >           |   |
| > 6-100         | Baton Rouge     | > Blvd.        | > 300 E.    |   |
| >               | 70806           | >              | > 8th St.,  |   |
| > Sacramento    |                 | > Suite 4      | > Rm. 500   |   |
| > 95814         | 1-800-256-4485  | >              | >           |   |
| >               |                 | > Las Cruces   | > Austin    |   |
| >               |                 | > 88011        | > 78701     |   |
|  1-800-851-1127 |                 | >              | >           |   |
|                 |                 | >              | > 1-8       |   |
|                 |                 | 1-800-530-8810 | 00-626-3142 |   |
+-----------------+-----------------+----------------+-------------+---+
| ☐ **COLORADO**  | ☐ **MARYLAND**  | ☐ **NEW YORK** | ☐ **UTAH**  |   |
|                 |                 |                |             |   |
| > 645 Parfet    | 50 Harry S.     | > 10B Airline  | > 176 N.    |   |
| > Street        | Truman Pkwy.    | > Drive        | > 2200 West |   |
| >               |                 | >              | >           |   |
| > Suite W-201   | Suite 202       | > Albany       | > Suite 260 |   |
| >               |                 | > 12235-1004   | >           |   |
| > Lakewood      | Annapolis 21401 | >              | > Salt Lake |   |
| > 80215-5517    |                 | >              | > City      |   |
| >               | 1-800-675-0295  | 1-800-821-1276 | > 84116     |   |
| >               |                 |                | >           |   |
|  1-800-392-3202 |                 |                | > 1-8       |   |
|                 |                 |                | 00-747-8522 |   |
+-----------------+-----------------+----------------+-------------+---+
| ☐ **DELAWARE**  | ☐ **MICHIGAN**  | ☐ **NORTH      | ☐           |   |
|                 |                 | CAROLINA**     | *           |   |
| > Dept. of      | 3001 Coolidge   |                | *VIRGINIA** |   |
| > Agriculture   | Road            | > 2 W. Edenton |             |   |
| > Bldg.         |                 | > Street       | > 102       |   |
| >               | Suite 400       | >              | > Governor  |   |
| > 2320 So.      |                 | > Raleigh      | > Street    |   |
| > Dupont Hwy.   | East Lansing    | > 27601-1085   |             |   |
| >               | 48823           | >              | Suite LL20  |   |
| > Dover, 19901  |                 | >              |             |   |
| >               | 1-800-453-7501  | 1-800-437-8451 | > Richmond  |   |
| > 1             |                 |                | > 23219     |   |
| -800-282-8685\* |                 |                | >           |   |
|                 |                 |                | > 1-8       |   |
|                 |                 |                | 00-772-0670 |   |
+-----------------+-----------------+----------------+-------------+---+
| ☐ **FLORIDA**   | ☐ **MINNESOTA** | ☐ **NORTH      | ☐           |   |
|                 |                 | DAKOTA**       | **W         |   |
| > 1222 Woodward | 8 East 4th      |                | ASHINGTON** |   |
| > Street        | Street,         | > NDSU \--     |             |   |
| >               |                 | > IACC Bldg.   | > 1111      |   |
| > Orlando 32803 | Suite 500       | >              | >           |   |
| >               |                 | > 1320         |  Washington |   |
| >               | St. Paul 55101  | > Albrecht     | > St., S.E. |   |
|  1-800-344-6277 |                 | > Blvd., Rm.   | >           |   |
|                 | 1-800-453-7502  | > 448          | > Olympia   |   |
|                 |                 | >              | > 98501     |   |
|                 |                 | > Fargo 58105  | >           |   |
|                 |                 | >              | > 1-8       |   |
|                 |                 | >              | 00-435-5883 |   |
|                 |                 | 1-800-626-3134 |             |   |
|                 |                 |                | Use for     |   |
|                 |                 |                | FedEx       |   |
|                 |                 |                | only\*\*\*  |   |
+-----------------+-----------------+----------------+-------------+---+
| ☐ **GEORGIA**   | ☐               | ☐ **OHIO**     | ☐ **WEST    |   |
|                 | **MISSISSIPPI** |                | VIRGINIA**  |   |
| > Stephens      |                 | > Bromfield    |             |   |
| > Federal       | 121 N.          | > Admin. Bldg. | > 1900      |   |
| > Building      | Jefferson       | >              | > Kanawha   |   |
| >               | Street          | > 8995 East    | > Blvd. E   |   |
| > 355 E.        |                 | > Main St.,    | >           |   |
| > Hancock Ave., | Suite 230       | > Room 103     | >           |   |
| > Suite 320     |                 | >              |  Charleston |   |
| >               | Jackson 39201   | > Reynoldsburg | > 25305     |   |
| > Athens 30601  |                 | > 43068        | >           |   |
| >               | 1-800-535-9609  | >              | > 1-8       |   |
| >               |                 | >              | 00-535-7088 |   |
|  1-800-253-4419 |                 | 1-800-858-8144 |             |   |
+-----------------+-----------------+----------------+-------------+---+
| ☐ **HAWAII**    | ☐ **MISSOURI**  | ☐ **OKLAHOMA** | ☐           |   |
|                 |                 |                | **          |   |
| > State Dept.   | 601 Business    | > 2800 N.      | WISCONSIN** |   |
| > of            | Loop West       | > Lincoln      |             |   |
| > Agriculture   |                 | > Blvd.        | > 2811      |   |
| > Bldg.         | Suite 240       | >              | >           |   |
| >               |                 | > Oklahoma     | Agriculture |   |
| > 1428 S. King  | Columbia 65203  | > City 73105   | > Dr.       |   |
| > Street        |                 | >              | >           |   |
| >               | 1-800-551-1014  | >              | > Madison   |   |
| > Honolulu      |                 | 1-888-525-9226 | > 53718     |   |
| > 96814         |                 |                | >           |   |
| >               |                 |                | > 1-8       |   |
| >               |                 |                | 00-789-9277 |   |
|  1-800-804-9514 |                 |                |             |   |
+-----------------+-----------------+----------------+-------------+---+
| ☐ **IDAHO**     | ☐ **MONTANA**   | ☐ **OREGON**   | ☐           |   |
|                 |                 |                | **WYOMING** |   |
| > 2224 Old      | USDA, NASS, MT  | > 1735 Federal |             |   |
| > Penitentiary  | FO              | > Building     | > 308 W.    |   |
| > Rd.           |                 | >              | > 21st      |   |
| >               | 10 West 15^th^, | > 1220 S.W.    | > Street    |   |
| > Boise 83712   | Suite 3100      | > Third Avenue | >           |   |
| >               |                 | >              | > Third     |   |
| >               | Helena 59626    | > Portland     | > Floor     |   |
|  1-800-691-9987 |                 | > 97204        | >           |   |
|                 | 1-800-835-2612  | >              | > Cheyenne  |   |
|                 |                 | >              | > 82001     |   |
|                 |                 | 1-800-338-2157 | >           |   |
|                 |                 |                | > 1-8       |   |
|                 |                 |                | 00-892-1660 |   |
+-----------------+-----------------+----------------+-------------+---+
| ☐ **ILLINOIS**  |                 |                | ☐ ANYWHERE  |   |
| ☐ **PUERTO      |                 |                |             |   |
| RICO** ☐ HQ \-- |                 |                |             |   |
| D.C.            |                 |                |             |   |
|                 |                 |                |             |   |
| > Dept. of      |                 |                |             |   |
| > Agriculture   |                 |                |             |   |
| > Bldg. Dept.   |                 |                |             |   |
| > of Ag. of     |                 |                |             |   |
| > Puerto Rico   |                 |                |             |   |
| > NASS/ DADO/   |                 |                |             |   |
| > HRS - Rm.     |                 |                |             |   |
| > 5058          |                 |                |             |   |
| >               |                 |                |             |   |
| > 801 Sangamon  |                 |                |             |   |
| > Avenue, Room  |                 |                |             |   |
| > 54 1309       |                 |                |             |   |
| > Fernandez     |                 |                |             |   |
| > Juncos 1400   |                 |                |             |   |
| > Independence  |                 |                |             |   |
| > Ave., SW      |                 |                |             |   |
| >               |                 |                |             |   |
| > Springfield   |                 |                |             |   |
| > 62702         |                 |                |             |   |
| > Santurce      |                 |                |             |   |
| > 00907-1163    |                 |                |             |   |
| > Washington,   |                 |                |             |   |
| > D.C.          |                 |                |             |   |
| > 20250-2000    |                 |                |             |   |
| >               |                 |                |             |   |
| >               |                 |                |             |   |
|  1-800-622-9865 |                 |                |             |   |
| > 787-723-3773  |                 |                |             |   |
| >               |                 |                |             |   |
|  1-800-832-4180 |                 |                |             |   |
+-----------------+-----------------+----------------+-------------+---+
| \*Toll-Free     |                 |                |             |   |
| Number Within   |                 |                |             |   |
| State Only.     |                 |                |             |   |
| \*\*Office also |                 |                |             |   |
| serves          |                 |                |             |   |
| Connecticut,    |                 |                |             |   |
| Maine,          |                 |                |             |   |
| Massachusetts,  |                 |                |             |   |
| Rhode Island,   |                 |                |             |   |
| Vermont.        |                 |                |             |   |
|                 |                 |                |             |   |
| \*\*\* Address  |                 |                |             |   |
| for mailing is  |                 |                |             |   |
| P.O. Box 609,   |                 |                |             |   |
| Olympia, WA     |                 |                |             |   |
| 98507-0609      |                 |                |             |   |
|                 |                 |                |             |   |
| **ATTENTION:    |                 |                |             |   |
| This form MUST  |                 |                |             |   |
| be signed. Read |                 |                |             |   |
| the following   |                 |                |             |   |
| information     |                 |                |             |   |
| carefully       |                 |                |             |   |
| before signing  |                 |                |             |   |
| this            |                 |                |             |   |
| statement**     |                 |                |             |   |
+-----------------+-----------------+----------------+-------------+---+

A false answer to any question on this form may be grounds for not
employing you, or for dismissing you after you begin work, and may be
punishable by fine or imprisonment (U.S. Code, Title 18, Sec. 1001). All
statements are subject to investigation, including a check of
fingerprints, police records, and former employers. All the information
you will give will be considered in reviewing your statement and is
subject to investigation.

  ------------------------------------ ----------------------------------
  **CERTIFICATION: I certify that all  **Signature (Sign in ink) Date
  of the statements made are true,     Signed**
  complete, and correct to the best of 
  my knowledge and belief, and are     
  made in good faith.**                

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