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**Job Title/Series/Grade: High Voltage Electrical Apprenticeship**

-   **Electrician Apprentice - BB-2810, Step I**

-   **Lineman Apprentice -- BB-2810, Step I**

-   **Substation Operator Apprentice -- BB-5407, Step I**

**Job Announcement Number: 005694-08**

**Duty Location: Throughout Washington, Oregon, Idaho and Montana**

**Position Information: This is a permanent position with a full-time
work schedule.**

**Anticipated Number of Positions To Be Filled: More than One (1)
position may be filled**

**Opening Date: 09/08/08**

**Closing Date: 10/30/08**

**Salary range: \$24.27 per hour.** In addition to the wage rate, BPA
currently pays a 3.16% differential (\$0.77 per hour) for each
non-overtime hour worked. This differential is separate from other
premiums that are paid under the negotiated collective bargaining
agreement.

**Organization**: **Transmission Services, Transmission Field Services,
Apprentices -- TFZ**

For information on BPA's Mission, Vision and Core Values, please click
on the following link: [About
BPA](http://www.bpa.gov/corporate/About_BPA/#values).

**Who May Be Considered:**

-   Career and Career Conditional Employees of Bonneville Power
    Administration**,**

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-   Transfer eligibles, Reinstatement eligibles, 30% or more Disabled
    Veterans, Veterans eligible to apply under the Veterans Employment
    Opportunity Act (VEOA) of 1998\*\*, VRA eligibles\*, and CTAP/ICTAP
    eligibles.

**\*\*To be eligible for a VEOA appointment, a veteran must:**

Be a preference eligible
[(VetInfo)](http://www.opm.gov/veterans/html/vetsInfo.asp) OR veteran
separated after 3 or more years of continuous active service performed
under honorable conditions.  Veterans who were released shortly before
completing a 3-year tour are considered to be eligible.  (\"Active
service\" defined in title 37, United States Code, means active duty in
the uniformed services and includes full-time training duty, annual
training duty, full-time National Guard duty, and attendance, while in
the active service, at a school designated as a service school by law or
by the Secretary concerned.)

## As a recognized world leader in power transmission, the Bonneville Power Administration (BPA) knows what makes us successful -- our people. To attract the most talented and dedicated professionals, not only do we offer one of the best compensation and benefits packages in the industry, we provide a comfortable work environment and an unlimited opportunity for individual achievement. In fact, the same cultural diversity that makes this region a great place to live also makes BPA an exciting place to work where people respect each other, with an employer who believes and promotes a healthy balance between work and family.

## 

## BPA has one of the most highly acclaimed high-voltage electrical [**apprentice programs**](http://www.transmission.bpa.gov/EdCar/Apprenticeships/) in the world. Our Electrical Apprenticeship Program consists of 3 ½ to 4 years of intensive classroom study, homework, and on the job training. End of step presentations, exams, and reviews are required every six months and if successful, the apprentice will be promoted to the next step of the apprenticeship program and finally to Journeyman. 

**Interested?** The following information will provide you with all the
steps necessary to apply.

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height="7.291666666666667e-2in"}

**What Work Will I Be Doing?**

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.

**Am I Qualified?**

**[SELECTIVE PLACEMENT FACTOR (Screen Out):]{.underline}** This position
has a selective factor, which 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 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;

-   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 on the following elements. **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**

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-   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]{.underline}** 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
    supplemental questionnaire for Electrical Apprenticeships.
    Candidates considered to be best qualified on the above-mentioned
    job elements may be further evaluated by a competency-based
    interview with the Apprentice Craft Committee

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

(**Written Aptitude Examination**)

-   The apprenticeship examination is a requirement 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 will
    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 you are eligible to test.** This notice will list all
    testing dates, locations and times. **Applicants 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 (this is **not** the student eligibility form
    which is attached to this announcement, but the notice we will send
    you that lets you know that we have made the determination you are
    eligible to test.) **(Applicants who travel to take the Apprentice
    Exam do so at their own expense).**

Apprentice exams are scheduled for **December 6th and 13^th^, 2008 in
Vancouver, Washington, and December 13th, 2008 in Spokane, Washington.**

**Working Conditions**

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. Apprentices can expect to be in a travel status
for a substantial amount of time and assignments away from the
headquarters will be required (may be up to 6 months in duration) to
complete some work processes.

**Physical Requirements**

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.

**Key Requirements:**

-   If selected you will be required to enter into a **\*\*"Continuation
    of Service" Agreement\*\*,** which will obligate you to remain with
    BPA following your apprenticeship training. In the event you fail to
    complete the required period of service with BPA, you would be
    liable, (indebted) in most cases, to BPA for the cost of the
    training received.

-   **This position has a selective factor which will serve as a
    screen-out element.**  You **must** submit a copy of your Employment
    driving record **(obtained from the Dept. of Motor Vehicles** or
    **equivalent State agency**, covering the past three years and dated
    within the last three months.  **Failure to provide will result in
    a rating of not qualified**. **Candidates with a poor driving record
    and/or revocation of license will be immediately disqualified from
    consideration** **(Details are provided in the 'Qualifications"
    section of the announcement, below.)**

-    **If selected, you will be required to pass a pre-appointment
    background check, drug screen and physical examination.**  This
    position is also subject to random drug testing.  Tentative
    selectees will be tested for the use of illegal drugs prior to final
    selection.  A determination of the use of illegal drugs may lead to
    non-selection (based on a failure to meet conditions of
    employment).  The successful applicant(s) will be subject to future
    random, unannounced testing.  Failure to pass subsequent tests may
    result in disciplinary action, including removal from the Federal
    Service. 

-   **Candidates considered to be best qualified may be further
    evaluated (e.g., interview panel) by the BPA Apprenticeship Craft
    Committee(s) for each craft as required.**

-   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.**

**\*\*Service Agreement:**

-   **If selected you will be required to enter into a "Continuation of
    Service" Agreement, prior to your entry on duty.** The agreement
    will obligate you to remain with BPA for a period of one (1) year
    upon completion of apprenticeship training. In the event you fail to
    complete the required period of service with BPA, you would be
    liable (indebted), in most cases, to BPA for the cost of the
    training received. Specific information regarding the Continuation
    Service Agreement will be provided to selected applicants in future
    correspondence. Of course, we are hopeful that you would remain with
    BPA for your entire career, as nearly all of BPA's electrical
    employees have chosen to do so.

**Special Conditions of Employment**

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.

-   Possess and maintain a valid commercial driver's license (CDL).

-   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 emergency call-outs.

-   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.

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height="1.2479166666666666in"}

**Does BPA Provide Accommodation for Applicants With a Disability?**

Yes. If you need a reasonable accommodation for any part of the
application and hiring process, please notify the agency. 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/).

**Questions?**

#### If you have questions or need a hard copy of this vacancy announcement, please e-mail us at <jobs@bpa.gov>

#### [Apprentice Application and Hiring Timeline]{.mark}

-   **September** - BPA Announcement Opens

-   **October** - BPA Announcement Closes

-   **December - Apprentice Written Examinations**

-   **Jan/Feb** - Craft Specific Application Rating

-   **March** - Apprentice Interviews

-   **April** - Selections

-   **June** - Hire Date (June 07, 2009)

**How Do I Apply for This Position?**

BPA's [Application Package Checklist](../checklist_for_students.doc) and
[Frequently Asked Questions
(FAQ's)](../APPRENTICE%20ANNOUNCEMENT%20FAQ.doc) 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).

**A complete application package [must]{.underline} include the
following:**

1.  Your resume, Optional Application for Federal Employment (OF-612),
    or other written application format of your choice that includes
    **all** the following bulleted information.

-   Position title and Announcement number of the position for which you
    are applying. (**Please check off which apprenticeship position(s)
    you are applying for on the first page of the supplemental
    questionnaire.)**

-   Your full name, mailing address, email address, and day and evening
    telephone numbers.

-   Country of citizenship.

-   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).

-   Indicate if we may contact your current supervisor.

-   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.

-   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).

**\*\*Please note that if your resume or application does not provide
all of the required information requested in the vacancy announcement,
you may lose consideration.**

#### Completed BPA Electrical Apprentice Supplemental Questionnaire is [REQUIRED]{.underline}. (Attached) Be sure to indicate on the 1^st^ page of the questionnaire, which apprenticeship position(s) you are applying for. 

2.  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 you are
    applying for consideration with 10-point veteran's preference, you
    must provide a copy of your DD-214 (Member 4), Standard Form 15
    (Application for 10-Point Veteran Preference), and documented proof
    of claim as specified on SF-15. ([SF-15
    form](http://www.opm.gov/forms/pdf_fill/SF15.pdf))

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

4.  All non-BPA applicants are encouraged to complete and submit BPA F
    3330-11e, Applicant Disability, Race/National Origin and Gender
    Identification form (attached).

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

\***All required information must be received by the closing date.
Applicants will not be contacted for missing information. Failure to
provide the required information will result in a rating of
not qualified.**

**Please retain a copy of your application as BPA does not return
applications or provide copies.**

Where Do I Send My Application?

Your complete application packet must be received no later than 12
mid-night Pacific (PT) 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.

**Forms Availability:**

All application materials may be obtained from all Bonneville Power
Administration Human Resources offices @ 905 NE 11^th^ Avenue, Portland,
OR 97232), or by calling 503-230-3230, or 1-877-975-4272 . You may also
download a copy of this announcement, including all forms from our
website at <http://www.jobs.bpa.gov./>

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.

> **Mail:**

Bonneville Power Administration

ATTN: Employment Center -- NHR-1

PO Box 3621

Portland, OR 97208-2621

> Personal Delivery:
>
> 905 NE 11^th^ Avenue, Portland, OR 97232

***Please note that if you do not currently have a building access pass,
and will be hand delivering your application, you will not be able to
gain access into the building after 6 p.m.***

> **Fax:**
>
> Fax your application to 503-230-3149. Applicants are responsible for
> ensuring that application materials transmit successfully.
>
> **Email:**

Applications should be sent as email attachments to: <jobs@bpa.gov>.
**The Announcement Number must be included in the subject line of the
email.** 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 at BPA. Applicants who
apply by email will receive an email confirmation. Applicants are
responsible for ensuring that application materials are formatted in a
manner that will transmit successfully.

**INFORMATION FOR DISPLACED FEDERAL EMPLOYEES:** 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}

**Websites:**

**Veterans Administration**

[www.va.gov](http://www.va.gov/)

**Bonneville Power Administration**

[www.bpa.gov](http://www.bpa.gov/)

**Office of Personnel Management Jobs**

[www.usajobs.opm.gov](http://www.usajobs.opm.gov/)

**Office of Personnel Management**

<http://www.opm.gov/qualifications/index.htm>

**Request Copies of Military Personnel Records**

<http://www.archives.gov/veterans/evetrecs/>

**The Bonneville Power Administration is a harassment free workplace.**

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<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"></td>
<td></td>
<td colspan="3">     </td>
</tr>
<tr class="even">
<td colspan="10"><strong>Name</strong></td>
<td></td>
<td colspan="3"><strong>Announcement #</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><strong>Evening</strong> (<em>Cellular)</em></td>
<td></td>
<td colspan="7"><strong>E-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>Electrician Apprentice</strong></td>
<td></td>
<td colspan="5"><strong>Substation Operator Apprentice</strong></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="5"><strong>Lineman Apprentice</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. Complete the entire questionnaire answering each
question completely and accurately. Your responses must reflect your
actual knowledge and skills.

**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 |   |                             |   |   |                             |
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| f |   |                             |   |   |                             |
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| r |   |                             |   |   |                             |
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| 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 |   |                             |
+---+---+-----------------------------+---+---+-----------------------------+
|   |   | Work with frequent          |   |   | Work from high places (15   |
|   |   | overnight travel (11 or     |   |   | feet and above)             |
|   |   | more nights per month)      |   |   |                             |
+---+---+-----------------------------+---+---+-----------------------------+
|   |   | Work when subject to        |   |   | Work around hazardous       |
|   |   | emergency call-outs (i.e.,  |   |   | materials (i.e., solvents,  |
|   |   | call to perform emergency   |   |   | PCB\'s, chemicals, etc.)    |
|   |   | work outside normal working |   |   |                             |
|   |   | hours)                      |   |   |                             |
+---+---+-----------------------------+---+---+-----------------------------+
|   |   | Work extended periods of    |   |   | Work around                 |
|   |   | overtime, including working |   |   | herbicides/pesticides       |
|   |   | weekends.                   |   |   |                             |
+---+---+-----------------------------+---+---+-----------------------------+
|   |   | Work under varying climatic |   |   | Work with a team or as a    |
|   |   | (rain, snow, ice, high      |   |   | member of a crew            |
|   |   | winds, etc.) conditions     |   |   |                             |
+---+---+-----------------------------+---+---+-----------------------------+
|   |   | Work around energized high  |   |   | Work in close and confined  |
|   |   | voltage (above 12.5kv)      |   |   | places                      |
|   |   | equipment.                  |   |   |                             |
+---+---+-----------------------------+---+---+-----------------------------+
|   |   | Work around moving          |   |   | Work with respirator or     |
|   |   | machinery                   |   |   | full face mask              |
+---+---+-----------------------------+---+---+-----------------------------+
|   |   | Work from ladders and       |   |   | Work alone in isolated      |
|   |   | scaffolds                   |   |   | locations                   |
+---+---+-----------------------------+---+---+-----------------------------+

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

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

**[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"><strong>Name</strong></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>

+----+----+------------------------------+---+------------------------+
| #  |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   | ### **Name** {#name-3} |
+----+----+------------------------------+---+------------------------+
| ## |    |                              |   |                        |
| ## |    |                              |   |                        |
| ## |    |                              |   |                        |
| #  |    |                              |   |                        |
| ** |    |                              |   |                        |
| Co |    |                              |   |                        |
| nt |    |                              |   |                        |
| in |    |                              |   |                        |
| ua |    |                              |   |                        |
| ti |    |                              |   |                        |
| on |    |                              |   |                        |
|  S |    |                              |   |                        |
| he |    |                              |   |                        |
| et |    |                              |   |                        |
| ** |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
| *  | ** |                              |   |                        |
| *E | Qu |                              |   |                        |
| le | es |                              |   |                        |
| me | ti |                              |   |                        |
| nt | on |                              |   |                        |
| ** | ** |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+
|    |    |                              |   |                        |
|    |    |                              |   |                        |
|    |    |                              |   |                        |
+----+----+------------------------------+---+------------------------+

**BPA Form F3330-11e**

**10/06**

**APPLICANT DISABILITY, RACE/NATIONAL ORIGIN AND GENDER IDENTIFICATION**

**(Please read the instructions and Privacy Act Statement before
completing this form)**

<table style="width:100%;">
<colgroup>
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 7%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 8%" />
<col style="width: 3%" />
<col style="width: 46%" />
<col style="width: 0%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="15"><p><strong><u>PRIVACY ACT STATEMENT</u></strong></p>
<p>This data is being collected to plan and evaluate the agency’s
recruitment of persons with disabilities, minorities and women, and to
help ensure that agency personnel practices meet the requirements of
Federal law and regulation. The data you supply will be used for
statistical analysis only. <strong>SUBMISSION OF THIS INFORMATION IS
VOLUNTARY</strong>. Failure to provide this information will have no
effect on the processing of your application for Federal employment.
Individual personnel selections are not made based on this
information.</p>
<p><u>Authority:</u> Sections 1302, 3301, 3302, 3304 and 7201 of Title 5
of the U.S. Code, Section 2000e of Title 42 of the U.S. Code; and
Section 791 of Title 29 of the U.S. Code.</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="13">1. Vacancy Announcement Number</td>
<td colspan="2">2. Position Title, Series, Grade</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="13"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="13">3. Name <em>(Last, First, Middle Initial)</em></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="13"><strong>     </strong></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">5. Gender</td>
<td></td>
<td colspan="2">Male</td>
<td></td>
<td colspan="9">Female</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="8"><strong>6. SECTION A. DISABILITY STATUS</strong></td>
<td colspan="4"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"><p>A person is disabled if he or she has a physical or
mental impairment, which substantially limits one or more major life
activities. Please read the disability descriptions below and then write
the two-digit numeric code in the box above which best describes your
disability, if any. If you have more than one disability, choose the one
which results in the most substantial limitation.</p>
<p><strong>01</strong>. I do not wish to identify my handicap
status.</p>
<p><strong>05</strong>. I do not have a disability</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><p><strong><u>SPEECH/HEARING/VISION
IMPAIRMENTS</u></strong></p>
<p><strong>13</strong>. Severe speech malfunction or inability to speak;
hearing is normal (Examples: defects of articulation [unclear
language</p>
<blockquote>
<p>sounds]; stuttering; aphasia [impaired language function];
laryngectomy [removal of the “voice box”]).</p>
</blockquote>
<p><strong>15</strong>. Hard of hearing (Total deafness in one ear or
inability to hear ordinary conversation, correctable with a hearing
aid).</p>
<p><strong>16</strong>. Total deafness in both ears, with understandable
speech.</p>
<p><strong>17</strong>. Total deafness in both ears, and unable to speak
clearly.</p>
<p><strong>22</strong>. Ability to read ordinary size print with
glasses, but with loss of peripheral (side) vision (Restriction of the
visual field to the</p>
<blockquote>
<p>extent that mobility is affected – “Tunnel vision”).</p>
</blockquote>
<p><strong>23</strong>. Inability to read ordinary size print, not
correctable by glasses (can read oversize print or use assisting devices
such as</p>
<blockquote>
<p>glass or projector modifier).</p>
</blockquote>
<p><strong>24</strong>. Blind in one eye</p>
<p><strong>25</strong>. Blind in both eyes (no usable vision, may have
some light perception)</p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"><p><strong><u>MISSING EXTREMITIES</u></strong></p>
<p><strong>27</strong>. One hand <strong>28</strong>. One arm
<strong>29</strong>. One foot <strong>32</strong>. One leg</p>
<p><strong>33</strong>. Both hands or arms <strong>34</strong>. Both
feet or legs</p>
<p><strong>35</strong>. One hand or arm <em><u>and</u></em> one foot or
leg <strong>36</strong>. One hand or arm <em><u>and</u></em> both feet
or legs</p>
<p><strong>37</strong>. Both hands or arms <em><u>and</u></em> one foot
or leg <strong>38</strong>. Missing both hands or arms
<em><u>and</u></em> both feet or legs.</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><p><strong><u>NONPARALYTIC ORTHOPEDIC
IMPAIRMENTS</u></strong> <em>(Because of chronic pain, stillness, or
weakness in bones or joints, there is some loss of ability to move or
use a part or parts of the body.)</em></p>
<p><strong>44</strong>. One or both hands <strong>45</strong>. One or
both feet <strong>46</strong>. One or both arms <strong>47</strong>. one
or both legs</p>
<p><strong>48</strong>. Hip or pelvis <strong>49</strong>. Back
<strong>57</strong>. Any combination of two or more parts of the
body</p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"><p><strong><u>PARTIAL PARALYSIS</u></strong>
<em>(Because of a brain, nerve, or muscle problem, including palsy and
cerebral palsy, there is some loss of ability to move or use a part of
the body, including legs, arms, and/or trunk.)</em></p>
<p><strong>61</strong>. One hand <strong>62</strong>. One arm, any part
<strong>63</strong>. One leg, any part <strong>64</strong>. Both
hands</p>
<p><strong>65</strong>. Both legs, any part <strong>66</strong>. Both
arms, any part</p>
<p><strong>67</strong>. One side of the body, including one arm and one
leg. <strong>68</strong>. Three or more major parts of the body (arms
and legs)</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><strong>7. <u>COMPLETE PARALYSIS</u></strong>
<em>(Because of a brain, nerve, or muscle problem, including palsy and
cerebral palsy, there is complete loss of ability to move or use a part
of the body, including legs, arms, and/or trunk.)</em></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"><p><strong>70</strong>. One hand <strong>71</strong>.
Both hands <strong>72</strong>. One arm <strong>73</strong>. Both
arms</p>
<p><strong>74</strong>. One leg <strong>75</strong>. Both legs
<strong>76</strong>. Lower half of body, including legs</p>
<p><strong>77</strong>. One side of body, including one arm and one
leg</p>
<p><strong>78</strong>. Three or more major parts of body (arms and
legs)</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><strong><u>OTHER IMPAIRMENTS</u></strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"><p><strong>80</strong>. Heart disease with no
restriction or limitation of activity <em>(History of heart problems
with complete recovery.)</em></p>
<p><strong>81</strong>. Heart disease with restriction or limitation of
activity</p>
<p><strong>82</strong>. Convulsive disorder <em>(e.g. epilepsy)</em></p>
<p><strong>83</strong>. Blood disease <em>(e.g. sickle cell anemia,
leukemia, hemophilia)</em></p>
<p><strong>84</strong>. Diabetes</p>
<p><strong>86</strong>. Pulmonary or respiratory disorders <em>(e.g.
tuberculosis, emphysema, asthma)</em></p>
<p><strong>87</strong>. Kidney dysfunction <em>(e.g. if dialysis [Use of
an artificial kidney machine is required])</em></p>
<p><strong>88</strong>. Cancer (<em>a history of cancer with complete
recovery)</em></p>
<p><strong>82</strong>. Cancer <em>(undergoing surgical and/or medical
treatment)</em></p>
<p><strong>90</strong>. Mental retardation <em>(Chronic and lifelong
condition involving a limited ability to learn, to be educated, and to
be trained for</em></p>
<blockquote>
<p><em>useful productive employment as certified by a State Vocational
Rehabilitation agency under section 213.3102(t)</em></p>
<p><em>of Schedule A.)</em></p>
</blockquote>
<p><strong>91</strong>. Mental or emotional illness <em>(A history of
treatment for mental or emotional problems.)</em></p>
<p><strong>92</strong>. Severe distortion of limbs and/or spine
<em>(e.g. dwarfism, severe distortion of the back)</em></p>
<p><strong>93</strong>. Disfigurement of face, hands, or feet (e.g.
distortion of features on skin, such as those caused by burns, gunshot
injuries,</p>
<blockquote>
<p>and birth defects [gross facial birthmarks, club feet, etc.])</p>
</blockquote>
<p><strong>94</strong>. Learning disability <em>(A disorder in one or
more of the processes involved in understanding, perceiving, or using
language</em></p>
<p><em>Or concepts [spoken or written]; e.g. dyslexia.)</em></p>
<p><strong>06</strong>. I have a disability, but it is not listed above:
Describe below:</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><strong>     </strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"><strong>SECTION B. ETHNICITY AND RACE IDENTIFICATION:
Specific Instructions:</strong> The two questions below are designed to
identify your ethnicity and race. <strong>Regardless of your answer to
question 1, go to question 2.</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><strong>Question 1. Are you Hispanic or
Latino?</strong> <em>(A person of Cuban, Mexican, Puerto Rican, South or
Central American, or other Spanish culture or origin, regardless of
race.)</em></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="3">Yes</td>
<td colspan="3"></td>
<td colspan="5">No</td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><strong>Question 2.</strong> Please select the racial
category or categories with which you most closely identify by placing
an “X” in the appropriate box(s). Check as many as apply.</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="9"><p><strong>RACIAL CATEGORY</strong></p>
<p><em><strong>(Check as many as apply)</strong></em></p></td>
<td colspan="2"></td>
<td colspan="5"><strong>DEFINITION OF CATEGORY</strong></td>
</tr>
<tr class="even">
<td></td>
<td colspan="8">American Indian or Alaska Native</td>
<td colspan="2"></td>
<td colspan="5">A person having origins in any of the original peoples
of North and South America <em>(including Central America)</em>, and who
maintains tribal affiliation or community attachment.</td>
</tr>
<tr class="odd">
<td colspan="11"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="8">Asian</td>
<td colspan="2"></td>
<td colspan="5">A person having origins in any of the original peoples
of the Far East, Southeast Asia, or the Indian subcontinent including,
for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan,
the Philippine Islands, Thailand, and Vietnam.</td>
</tr>
<tr class="odd">
<td colspan="11"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="8">Black or African American</td>
<td colspan="2"></td>
<td colspan="5">A person having origins in any of the black racial
groups of Africa</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="8"></td>
<td colspan="2"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="8">Native Hawaiian or Other Pacific Islander</td>
<td colspan="2"></td>
<td colspan="5">A person having origins in any of the original peoples
of Hawaii, Guam, Samoa, or other Pacific Islands.</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="8"></td>
<td colspan="2"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="8">White</td>
<td colspan="2"></td>
<td colspan="5">A person having origins in any of the original peoples
of Europe, the Middle East, or North Africa.</td>
</tr>
</tbody>
</table>