Part 94, page 47

Transcript

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

Budget Bureau Approved 50-R0387

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PERSONAL QUALIFICATIONS STATEMENT

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 [blank]

8. Social Security Number [blank]

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

9. If you are currently on a register of eligibles for appointment to a Federal position, give the name of the examination, the name of the office maintaining the register, the date on your notice of rating, and your rating. [blank]

2. Home telephone Area Code Number [blank]

3. Business telephone Area Code Number b6 per BOC b7C per BOC

4. Name (Last) (First) (Middle) (Maiden, if any) [X] Mr. [ ] Miss [ ] Mrs. [redacted]

10. Lowest pay or grade you will accept PAY $_____ per _____ OR GRADE GS-4

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

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

6. City State ZIP Code [blank]

12. When will you be available? [blank]

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

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

14. EDUCATION (A) Did you graduate from high school or will you graduate within the next nine months? YES [GRADUATED] 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 From To Years completed Day Night Credits completed Semester hours Quarter hours Type of degree Year of degree [blank rows]

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

(E) Chief graduate college subjects [partially visible/redacted] 10[illegible]-[illegible]-278 Credits completed Semester hours Quarter hours [blank]

(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 if known) of school, dates attended, subjects studied, certificates, and any other pertinent data. [blank]

15. HONORS, AWARDS, AND FELLOWSHIPS RECEIVED [blank] b6 per BOC

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

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

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SEARCHED _____ INDEXED _____ SERIALIZED _____ FILED _____ MAR 3 1972 FBI — PORTLAND

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DB Cooper-41966 b6 per BOC

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Standard Form 171 (Formerly SF 57) July 1968 U.S. Civil Service Commission

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THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER