Form SF-171 "Application for Federal Employment"

What Is Form SF-171?

This is a legal form that was released by the U.S. Office of Personnel Management on June 1, 1988 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 1988;
  • The latest available edition released by the U.S. Office of Personnel Management;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SF-171 by clicking the link below or browse more documents and templates provided by the U.S. Office of Personnel Management.

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Released 6/29/00.
Application for Federal Employment - SF 171
Form Approved
OMB No. 3206-0012
Read the instructions before you complete this application. Type or print clearly in dark ink.
GENERAL INFORMATION
DO NOT WRITE IN THIS AREA
What kind of job are you applying for? Give title and announcement no. (if any)
1
FOR USE OF EXAMINING OFFICE ONLY
Date entered register
Form reviewed:
Form approved:
2
Social Security Number
3
Sex
Male
Female
Earned
Veteran
Augmented
Option
Grade
Rating
Preference
Rating
Birth date (Month, Day, Year)
Birthplace (City and State or Country)
4
5
No
Preference
Claimed
6
Name (Last, First, Middle)
5 Points
(Tentative)
10 Pts. (30%
Mailing address (include apartment number, if any)
or More
Comp. Dis.)
City
State
ZIP Code
10 Pts. (Less
than 30%
Comp. Dis.)
Other
10 Points
Other names ever used (e.g., maiden name, nickname, etc.)
7
Initials and Date
Being
Investi-
Disallowed
gated
Home Phone
Work Phone
8
9
FOR USE OF APPOINTING OFFICE ONLY
Area Code
Number
Area Code
Number
Extension
Preference has been verified through proof that the separation was
under honorable conditions, and other proof as required.
10-point - 30% or More
10-point - Less Than 30%
10-Point -
Were you ever employed as a civilian by the Federal Government? If "NO", go to
10
5-Point
Compensable Disability
Compensable Disability
Other
Item 11. If "YES ", mark each type of job you held with an "X".
Signature and Title
Temporary
Career-Conditional
Career
Excepted
What is your highest grade, classification series and job title?
Agency
Date
Dates at highest grade: FROM
TO
AVAILABILITY
MILITARY SERVICE AND VETERAN PREFERENCE (Cont.)
1
1
When can you start work?
1
2
1
9
What is the lowest pay you will accept? (You will
YES NO
Were you discharged from the military service under honorable
not be considered for jobs which pay less than you
(Month and Year)
conditions? (If your discharge was changed to "honorable" or "general"
indicate.)
by a Discharge Review Board, answer "YES". If you received a clemency
discharge, answer "NO".)
Pay $
Per
OR Grade
If "NO ", provide below the date and type of discharge you received.
1
3
In what geographic area(s) are you willing to work?
Discharge Date
Type of Discharge
(Month, Day, Year)
1
4
Are you willing to work:
YES NO
List the dates (Month, Day, Year) , and branch for all active duty military service
2
0
From
To
Branch of Service
A.
40 hours per week (full-time)?
B.
25-32 hours per week (part-time)?
C.
17-24 hours per week (part-time)?
2
1
If all your active duty was after October 14, 1976, list the full names and dates of all
campaign badges or expeditionary medals you received or were entitled to receive.
D.
16 or fewer hours per week (part-time)?
E.
An intermittent job (on call/seasonal)?
F.
Weekends, shifts, or rotating shifts?
Are you willing to take a temporary job lasting:
1
5
Read the instructions that came with this form before completing this item.
2
2
When you have determined your eligibility for veteran preference from the
A.
5 to 12 months (sometimes longer)?
instructions, place an "X" in the box next to your veteran preference claim.
B.
1 to 4 months?
NO PREFERENCE
C.
Less than 1 month?
5-POINT PREFERENCE - You must show proof when you are hired.
Are you willing to travel away from home for:
1
6
A.
1 to 5 nights each month?
10-POINT PREFERENCE - If you claim 10-point preference, place an "X" in the
box below next to the basis for your claim.
To receive 10-point preference you
B.
6 to 10 nights each month?
must also complete a Standard Form 15, Application for 10-Point Veteran
C. 11 or more nights each month?
Preference, which is available from any Federal Job Information Center. ATTACH
THE COMPLETED SF 15 AND REQUESTED PROOF TO THIS APPLICATION.
MILITARY SERVICE AND VETERAN PREFERENCE
Non-compensably disabled or Purple Heart recipient.
Have you served in the United States Military Service? If your only
YES NO
1
7
active duty was training in the Reserves or National Guard,
Compensably disabled, less than 30 percent.
answer "NO", If "NO", go to item 22.
Spouse, widow(er), or mother of a deceased or disabled veteran.
Did you or will you retire at or above the rank of major or
1
8
lieutenant commander?
Compensably disabled, 30 percent or more.
THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
NSN 7540-00-935-7150
171-110
Standard Form 171 (Rev. 6-88)
U.S. Office of Personnel Management
PREVIOUS EDITION USABLE UNTIL 12-31-90
FPM Chapter 295
Page 1
Released 6/29/00.
Application for Federal Employment - SF 171
Form Approved
OMB No. 3206-0012
Read the instructions before you complete this application. Type or print clearly in dark ink.
GENERAL INFORMATION
DO NOT WRITE IN THIS AREA
What kind of job are you applying for? Give title and announcement no. (if any)
1
FOR USE OF EXAMINING OFFICE ONLY
Date entered register
Form reviewed:
Form approved:
2
Social Security Number
3
Sex
Male
Female
Earned
Veteran
Augmented
Option
Grade
Rating
Preference
Rating
Birth date (Month, Day, Year)
Birthplace (City and State or Country)
4
5
No
Preference
Claimed
6
Name (Last, First, Middle)
5 Points
(Tentative)
10 Pts. (30%
Mailing address (include apartment number, if any)
or More
Comp. Dis.)
City
State
ZIP Code
10 Pts. (Less
than 30%
Comp. Dis.)
Other
10 Points
Other names ever used (e.g., maiden name, nickname, etc.)
7
Initials and Date
Being
Investi-
Disallowed
gated
Home Phone
Work Phone
8
9
FOR USE OF APPOINTING OFFICE ONLY
Area Code
Number
Area Code
Number
Extension
Preference has been verified through proof that the separation was
under honorable conditions, and other proof as required.
10-point - 30% or More
10-point - Less Than 30%
10-Point -
Were you ever employed as a civilian by the Federal Government? If "NO", go to
10
5-Point
Compensable Disability
Compensable Disability
Other
Item 11. If "YES ", mark each type of job you held with an "X".
Signature and Title
Temporary
Career-Conditional
Career
Excepted
What is your highest grade, classification series and job title?
Agency
Date
Dates at highest grade: FROM
TO
AVAILABILITY
MILITARY SERVICE AND VETERAN PREFERENCE (Cont.)
1
1
When can you start work?
1
2
1
9
What is the lowest pay you will accept? (You will
YES NO
Were you discharged from the military service under honorable
not be considered for jobs which pay less than you
(Month and Year)
conditions? (If your discharge was changed to "honorable" or "general"
indicate.)
by a Discharge Review Board, answer "YES". If you received a clemency
discharge, answer "NO".)
Pay $
Per
OR Grade
If "NO ", provide below the date and type of discharge you received.
1
3
In what geographic area(s) are you willing to work?
Discharge Date
Type of Discharge
(Month, Day, Year)
1
4
Are you willing to work:
YES NO
List the dates (Month, Day, Year) , and branch for all active duty military service
2
0
From
To
Branch of Service
A.
40 hours per week (full-time)?
B.
25-32 hours per week (part-time)?
C.
17-24 hours per week (part-time)?
2
1
If all your active duty was after October 14, 1976, list the full names and dates of all
campaign badges or expeditionary medals you received or were entitled to receive.
D.
16 or fewer hours per week (part-time)?
E.
An intermittent job (on call/seasonal)?
F.
Weekends, shifts, or rotating shifts?
Are you willing to take a temporary job lasting:
1
5
Read the instructions that came with this form before completing this item.
2
2
When you have determined your eligibility for veteran preference from the
A.
5 to 12 months (sometimes longer)?
instructions, place an "X" in the box next to your veteran preference claim.
B.
1 to 4 months?
NO PREFERENCE
C.
Less than 1 month?
5-POINT PREFERENCE - You must show proof when you are hired.
Are you willing to travel away from home for:
1
6
A.
1 to 5 nights each month?
10-POINT PREFERENCE - If you claim 10-point preference, place an "X" in the
box below next to the basis for your claim.
To receive 10-point preference you
B.
6 to 10 nights each month?
must also complete a Standard Form 15, Application for 10-Point Veteran
C. 11 or more nights each month?
Preference, which is available from any Federal Job Information Center. ATTACH
THE COMPLETED SF 15 AND REQUESTED PROOF TO THIS APPLICATION.
MILITARY SERVICE AND VETERAN PREFERENCE
Non-compensably disabled or Purple Heart recipient.
Have you served in the United States Military Service? If your only
YES NO
1
7
active duty was training in the Reserves or National Guard,
Compensably disabled, less than 30 percent.
answer "NO", If "NO", go to item 22.
Spouse, widow(er), or mother of a deceased or disabled veteran.
Did you or will you retire at or above the rank of major or
1
8
lieutenant commander?
Compensably disabled, 30 percent or more.
THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
NSN 7540-00-935-7150
171-110
Standard Form 171 (Rev. 6-88)
U.S. Office of Personnel Management
PREVIOUS EDITION USABLE UNTIL 12-31-90
FPM Chapter 295
Page 1
WORK EXPERIENCE If you have no work experience, write "NONE" in A below and go to 25 on page 3.
2
3
YES NO
May we ask your present employer about your character, qualifications, and work record? A "NO" will not affect our review of your
qualifications. If you answer "NO" and we need to contact your present employer before we can offer you a job, we will contact you first.
.
READ WORK EXPERIENCE IN THE INSTRUCTIONS BEFORE YOU BEGIN.
24
.
INCLUDE MILITARY SERVICE -- You should complete all parts of the experience block just
as you would for a non-military job, including all supervisory experience. Describe each
Describe your current or most recent job in Block A and work backwards, describing
major change of duties or responsibilities in a separate experience block.
each job you held during the past 10 years. If you were unemployed for longer than 3
.
months within the past 10 years, list the dates and your address(es) in an experience block.
.
IF YOU NEED MORE SPACE TO DESCRIBE A JOB -- Use sheets of paper the same size as
You may sum up in one block work that you did more than 10 years ago. But, if that
this page (be sure to include all information we ask for in A and B below). On each
work is related to the type of job you are applying for, describe each related job in a
sheet show your name, Social Security Number, and the announcement number or job
separate block.
title.
.
.
INCLUDE VOLUNTEER WORK. (non-paid work) -- If the work (or a part of the work) is
IF YOU NEED MORE EXPERIENCE BLOCKS, use the SF 171-A or a sheet of paper.
like the job you are applying for, complete all parts of the experience block just as
.
you would for a paying job. You may receive credit for work experience with religious,
IF YOU NEED TO UPDATE (ADD MORE RECENT JOBS), use the SF 172 or a sheet of
community, welfare, service, and other organizations.
paper as described above.
Average number of
Number of employees
A
Name and address of employer's organization (include ZIP Code, if known)
Dates employed (gi v e month, day and year)
hours per week
you supervise
From:
To:
Salary or earnings
Your reason for leaving
$
per
Starting
$
per
Ending
Your immediate supervisor
Exact title of your job
If Federal employment (civilian or military) list series, grade or
Area CodeTelephone No.
rank, and, if promoted in this job, the date of your last promotion
Name
Description of work: Describe your specific duties, responsibilities and accomplishments in this job, including the job title(s) of any employees you supervise. If you
describe more than one type of work (for example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
For Agency Use (skill codes, etc.)
B
Name and address of employer's organization (include ZIP Code, if known)
Average number of
Number of employees
Dates employed (gi v e month, day and year)
hours per week
you supervised
From:
To:
Salary or earnings
Your reason for leaving
$
per
Starting
$
per
Ending
Your immediate supervisor
Exact title of your job
If Federal employment (civilian or military) list series, grade or
Area CodeTelephone No.
rank, and, if promoted in this job, the date of your last promotion
Name
Description of work: Describe your specific duties, responsibilities and accomplishments in this job, including the job title(s) of any employees you supervised. If you
describe more than one type of work (for example, carpentry and painting, or personnel and budget), write the approximate percentage of time you spent doing each.
For Agency Use (skill codes, etc.)
Page 2
IF YOU NEED MORE EXPERIENCE BLOCKS, USE SF 171-A (SEE BACK OF INSTRUCTION PAGE).
ATTACH ANY ADDITIONAL FORMS AND SHEETS HERE
EDUCATION
Did you graduate from high school? If you have a GED high school
Write the name and location (city and state) of the last high school you attended or
2
5
2
6
equivalency or will graduate within the next nine months, answer "YES ".
where you obtained your GED high school equivalency.
If "YES", give month and year graduated
YES
Have you ever attended
If "YES ", continue with 28.
2
7
YES
or received GED equivalency:
college or graduate
NO
If "NO", give the highest grade you completed:
NO
If "NO ", go to 31 .
school?
2
8
NAME AND LOCATION (city, state and ZIP Code) OF COLLEGE OR UNIVERSITY. If you expect to grad-
TYPE OF
MONTH
MONTH AND YEAR
NUMBER OF CREDIT
DEGREE
AND
uate within nine months, give the month and year you expect to receive your degree:
ATTENDED
HOURS COMPLETED
(e.g. B.A.,
YEAR OF
Name
City
State
ZIP Code
From
To
Semester Quarter
M.A.)
DEGREE
1)
2)
3)
2
9
NUMBER OF CREDIT
3
0
NUMBER OF CREDIT
CHIEF UNDERGRADUATE SUBJECTS
CHIEF GRADUATE SUBJECTS
HOURS COMPLETED
HOURS COMPLETED
Show major on the first line
Show major on the first line
Semester
Quarter
Semester
Quarter
1)
1)
2)
2)
3)
3)
If you have completed any other courses or training related to the kind of jobs you are applying for (trade, vocational, Armed Forces, business) give information below.
3
1
MONTH AND YEAR
TRAINING
NAME AND LOCATION (city, state and ZIP Code) OF SCHOOL
CLASS-
COMPLETED
ATTENDED
ROOM
SUBJECT(S)
HOURS
From
To
YES
NO
School Name
1)
City
State ZIP Code
School Name
2)
City
State ZIP Code
SPECIAL SKILLS, ACCOMPLISHMENTS AND AWARDS
3
2
Give the title and year of any honors, awards or fellowships you have received. List your special qualifications, skills or accomplishments that may help you get a job.
Some examples are: skills with computers or other machines; most important publications (do not submit copies); public speaking and writing experience; membership
in professional or scientific societies; patents or inventions; etc.
How many words per
List job-related licenses or certificates that you have, such as: registered nurse; lawyer; radio operator; driver's; pilot's; etc.
3
3
3
4
minute can you:
DATE OF LATEST LICENSE
STATE OR OTHER
LICENSE OR CERTIFICATE
TYPE? TAKE DICTATION?
OR CERTIFICATE
LICENSING AGENCY
1)
Agencies may test your
2)
skills before hiring you.
Do you speak or read a language other than English (include sign
If "YES", list each language and place an "X" in each column that applies to you.
3
5
YES
language) ? Applicants for jobs that require a language other than
If "NO", go to 36.
NO
English may be given an interview conducted solely in that language.
CAN PREPARE AND
CAN READ ARTICLES
CAN SPEAK AND UNDERSTAND
CAN TRANSLATE ARTICLES
LANGUAGE(S)
FOR OWN USE
GIVE LECTURES
Fluently
With Difficulty
Fluently
Passably
Into English
From English
Easily
With Difficulty
1)
2)
R E F E R E N C E S
3
6
List three people who are not related to you and are not supervisors you listed under 24 who know your qualifications and fitness for the kind of job for which you are applying.
At least one should know you well on a personal basis.
TELEPHONE NUMBER(S)
PRESENT BUSINESS OR HOME ADDRESS
FULL NAME OF REFERENCE
STATE
ZIP CODE
(Include Area Code)
(Number, street and city)
1)
2)
3)
Page 3
BACKGROUND INFORMATION --
You must answer each question in this section before we can process your application.
3
7
YES NO
Are you a citizen of the United States? (In most cases you must be a U.S. citizen to be hired. You will be required to submit proof of
identity and citizenship at the time you are hired.) If "NO", give the country or countries you are a citizen of:
NOTE: It is important that you give complete and truthful answers to questions 38 through 44. If you answer "YES" to any of them,
provide your explanation(s) in Item 45. Include convictions resulting from a plea of nolo contendere (no contest). Omit: 1) traffic fines of $100.00 or less;
2) any violation of law committed before your 16th birthday; 3) any violation of law committed before your 18th birthday, if finally decided in
juvenile court or under a Youth Offender law; 4) any conviction set aside under the Federal Youth Corrections Act or similar State law; 5) any
conviction whose record was expunged under Federal or State law. We will consider the date, facts, and circumstances of each event you list. In
most cases you can still be considered for Federal jobs. However, if you fail to tell the truth or fail to list all relevant events or circumstances, this
may be grounds for not hiring you, for firing you after you begin work or for criminal prosecution (18 USC 1001).
YES NO
3
8
During the last 10 years, were you fired from any job for any reason, did you quit after being told that you would be fired, or did you
leave by mutual agreement because of specific problems?
3
9
Have you ever been convicted of, or forfeited collateral for any felony violation? (Generally, a felony is defined as any violation of law
punishable by imprisonment of longer than one year, except for violations called misdemeanors under State law which are punishable by
imprisonment of two years or less.)
4
0
Have you ever been convicted of, or forfeited collateral for any firearms or explosives violation?
4
1
Are you now under charges for any violation of law?
4
2
During the last 10 years have you forfeited collateral, been convicted, been imprisoned, been on probation, or been on parole? Do not
include violations reported in 39, 40, or 41, above
4
3
Have you ever been convicted by a military court-martial? If no military service, answer "NO"
4
4
Are you delinquent on any Federal debt? (Include delinquencies arising from Federal taxes, loans, overpayment of benefits, and other
debts to the U.S. Government plus defaults on Federally guaranteed or insured loans such as a student and home mortgage loans.)
4
5
If "YES" in:
38 -
Explain for each job the problem(s) and your reason(s) for leaving. Give the employer's name and address.
39 through 43 -
Explain each violation. Give place of occurrence and name/address of police or court involved.
44 -
Explain the type, length and amount of the delinquency or default, and steps you are taking to correct errors or repay the debt. Give any
identification number associated with the debt and the address of the Federal agency involved.
NOTE: If you need more space, use a sheet of paper, and include the item number.
Item
Date
Explanation
Mailing Address
No.
(Mo./Yr.)
Name of Employer, Police, Court, or Federal Agency
City
State ZIP Code
Name of Employer, Police, Court, or Federal Agency
City
State ZIP Code
YES NO
Do you receive, or have you ever applied for retirement pay, pension, or other pay based on military, Federal civilian, or District of
4
6
Columbia Government service?
Do any of your relatives work for the United States Government or the United States Armed Forces? Include: father; mother; husband;
4
7
wife; son; daughter; brother; sister; uncle; aunt; first cousin; nephew; niece; father-in-law; mother-in;law; son-in-law; daughter-in-law;
brother-in-law; sister-in-law; stepfather; stepmother; stepson; stepdaughter; stepbrother; stepsister; half brother; and half sister
If "YES", provide details below. If you need more space, use a sheet of paper.
Name
Relationship
Department, Agency or Branch of Armed Forces
SIGNATURE, CERTIFICATION, AND RELEASE OF INFORMATION
YOU MUST SIGN THIS APPLICATION.
Read the following carefully before you sign.
.
A false statement on any part of your application may be grounds for not hiring you, or for firing you after you begin work. Also, you may be punished
by fine or imprisonment (U.S. Code, title 18, section 1001).
.
If you are a male born after December 31, 1959 you must be registered with the Selective Service System or have a valid exemption in order to be
eligible for Federal employment. You will be required to certify as to your status at the time of appointment.
.
I understand that any information I give may be investigated as allowed by law or Presidential order.
.
I consent to the release of information about my ability and fitness for Federal employment by employers, schools, law enforcement agencies and other
individuals and organizations, to investigators, personnel staffing specialists, and other authorized employees of the Federal Government.
.
I certify that, to the best of my knowledge and belief, all of my statements are true, correct, complete, and made in good faith.
4
8
SIGNATURE (Sign each application in dark ink)
4
9
DATE SIGNED (Month, day, year)
*U.S. Government Printing Office: 1992 312-071/50114
Page 4
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