Part 26, page 35

Transcript

The scan is the source; the transcript is machine-generated from it.

PERSONAL QUALIFICATIONS STATEMENT Budget Bureau Approved 50-R0387

1a. Kind of position (job) you are filing for (or title of examination) Customs Security Officer b. Announcement number [blank] 7. Birth date Month | Day | Year 8. Social Security b6 Per BOC b7C Per BOC

c. Options for which you wish to be considered (if listed in examination announcement) [blank]

d. Primary place(s) you wish to be employed Open

2. Home telephone Area Code | Number 3. Business telephone Area Code | Number b6 Per BOC 4. Name (Last) (First) (Middle) (Maiden if any) [X] Mr. [ ] Miss [ ] Mrs.

5. Number and street, R.D., or Post Office box number

10. Lowest pay or grade you will accept PAY $_____ per _____ OR b6 Per BOC b7C Per BOC

6. City | State | ZIP Code

11. Are you willing to travel? (Check one) [NO] [SOME] [OFTEN] X

12. When will you be available? [blank]

13. Will you accept: YES NO (A) Temporary appointment of —1 month or less? X —1 to 4 months? X —4 to 12 months? X (B) Less than full time work? (Less than 40 hours per week) X

(C) Will you accept a job in: YES NO —Washington, D.C.? X —any place in the United States? X —outside of the United States? X —only in (specify):

14. EDUCATION (A) Did you graduate from high school or will you graduate within the next nine months? [X] YES/[IN/AT] | NO | HIGHEST GRADE COMPLETED X

(B) Name and location (city and State) of last high school attended b6 Per BOC

(C) Name and location (city, State, and ZIP Code if known) of college or university. (If you expect to graduate within 9 months, give MONTH and year you expect degree.)

Dates attended | Years completed | Credits completed From | To | Day | Night | Semester | Quarter | Type of | Year of hours hours degree degree [blank rows]

(D) Chief undergraduate college subjects Credits completed Semester | Quarter hours hours [blank rows]

(E) Chief graduate college subjects Credits completed Semester | Quarter hours hours [blank rows]

(F) Major field of study at highest level of college work [blank]

(G) Other schools or training (for example, trade, vocational, armed forces, or business). Give for each the name and location (city, State, and ZIP Code b6 Per BOC of school, dates attended, subjects studied, certificates and any other pertinent data [blank]

15. HONORS, AWARDS, AND FELLOWSHIPS RECEIVED [blank]

16. FOREIGN LANGUAGES Enter foreign languages and indicate your knowledge of each by placing "X" in proper columns Reading | Speaking | Understanding | Writing Excl Good Fair | Excl Good Fair | Excl Good Fair | Excl Good Fair [blank rows]

17. Special qualifications and skills (licenses; skills with machines, patents or inventions; publications — do not submit copies unless requested, public speaking, b6 Per BOC memberships in professional or scientific societies; typing or shorthand speed; etc.) [blank]

DB Cooper-7188

THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER Standard Form 171 (Formerly SF 57) July 1968 U.S. Civil Service Commission