APPLICATION FOR KADENA VACANCY ANNOUNCEMENT(This form is subject to the Privacy Act of 1974)*
Announcement No.

*Organization name and duty location applying forPosition title, JD No., and grade applying for

PERSONAL STATEMENT*

Last Name*

Current Position Title & Grade*First Name

BWT*

Supervisor's Name *Supervisor's Phone*

Type of Contract

Current Organization & Location
MLC

Work Phone

Home Phone

Cell Phone-IHA

MCType of Employment

E-mail Address

Permanent
Limited/Seasonal*

DATE OF BIRTH

1 Apr 1970

*NTE:
OtherCurrent Address

Specify:

Education
Name and Location (City and Province) of High School
School Name:
Graduate:

Location:
YES

Graduate (Month/Year):NO

University/CollegeSchool

FROM

Month - YearTO

Major Field
Graduate

Address

YESAssociate

Type of Degree

Bachelor

MastersNO

DoctoralSchoolFROMMonth - YearTO

Major Field
Graduate

Address

YESAssociate

Type of Degree

Bachelor

MastersNO

DoctoralTechnical/Vocational/Language (ESL) School
SchoolFROMMonth - YearTO

Major Field
Graduate

Address

YES

SchoolFROMNOMonth - YearTO

Major Field
Graduate

Address

YES

Are you a family memberof a SOFA status personnel?
YES

List your family member/relatives who are employedin the command where this position is located, or none.

NO

Have you ever been arrested, indicted or convicted for any violationof law? If so, state complete circumstances. If not, state none.

NOI have read the qualifications required for this position and believe that I meet these requirements. I also understand that it is my responsibility to ensure that myapplication reaches the Civilian Personnel Office prior to the closing date/time. I understand that falsification of any item herein may result in the immediate
termination of my employment or disapproval of my application. I place my signature in certification that the information contained herein is the truth to the best ofmy knowledge and belief.
Date of Applying

KADENA AB Form 1EJ, 20090413

SIGNATURE OF EMPLOYEEPage 1 of 4 Pages

Language Proficiency
English Proficiency

Mon/Yr

Mon/YrSTEP
TOEFL(LAD)

TOEIC

Other English Skills/Certificates

I have a Native Command of English

Typing/Computer Related Skills/ English Typing :WPM (Number of Words Per Minute /Certifications related to computer/computer software

Attach copies of cerfiticates if you are applying for the position which requires.

123Licenses/Job related Skill Certifications
Attach copies of cerfiticates if you are applying for the position which requires.

12345678

Training Courses

12345Awards

123Remarks -This block may be used as a continuation for Education, Listing of the employed family members, Licenses, Awards, etc...

KADENA AB Form 1EJ, 20090413

Page 2 of 4 Pages

EMPLOYMENT HISTORYTo determine qualifications, state the description of your experience.

1Employer
Month / YearFROMTOLocation

Present

Job Title

Reason for
Leaving
Duties2Employer
Month / Year
FROM

TO

Location
Job Title

Reason for
Leaving
Duties3Employer
Month / Year
FROM

TO

Location
Job Title

Reason for
Leaving
Duties

KADENA AB Form 1EJ, 20090413

Page 3 of 4 Pages

To determine qualifications, state the description of your experience.

4Employer
Month / Year
FROM

TO

Location
Job Title

Reason for
Leaving
Duties5

EmployerMonth / Year
FROM

TO

Location
Job Title

Reason for
Leaving
DutiesEmployer

6

Month / Year
FROM

TO

Location
Job Title

Reason for
Leaving
Duties

PRIVACY ACT STATEMENTAUTHORITY: 10 U.S.C. 8013, Secretary of the Air Force: powers and duties; delegation by, and E.O. 9397 (SSN). PURPOSE(S): Used for Interviewing.
ROUTINE USES: Used as an application form filled by current USFJ employees to apply for positions under the internal recruitment program.
DISCLOSURE: Voluntary. However, failure to do so may delay or prevent action on the application.
KADENA AB Form 1EJ, 20090413

Page 4 of 4 Pages