Continuation sheet

Retrieve Data

Reset Form

Standard Form 171-A Continuation Sheet for SF 171

Form Approved:

OMB No. 3206-0012

Attach all SF 171-A's to your application at the top of page 3.

1. Name (Last, First, Middle Initial)

2. Social Security Number

3. Job Title or Announcement Number You Are Applying For

4. Date Completed

ADDITIONAL WORK EXPERIENCE BLOCKS

Nam e and ad dr ess of employer's organization(include ZIP Code, if known)

Dates employed (give month, day and year) Average number of hours per week
From:

To:
Your reason for wanting to leave

Salary or earnings

Your immediate supervisor
Name

Number of employees
you supervise

Starting $

per

Ending $

per
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, the date of your last promotion

Exact title of your job
Tel eph
phone No.

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.)
Name and address of employer's organization (include ZIP Code, if known)

Dates employed (give month, day and year) Average number of hours per week
From:

To:
Your reason for leaving

Salary or earnings

Your immediate supervisor
Name

Number of employees
you supervise

Starting $

per

Ending $

per
If Federal employment (civilian or military) list series, grade or rank, and, if promoted in this job, the date of your last promotion

Exact title of your job
Telephone No.

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.)

THE FEDERAL GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER

PREVIOUS EDITION USABLE UNTIL 12-31-90

Save Data

NSN 7540-00-935-7157

Print

171-206

Email Form

Standard Form 171-A (Rev. 6-88)
U.S. Office of Personnel Management
FPM Chapter 295

Next Page

Previous Page

Standard Form 171-A Continuation Sheet for SF 171 (Back)

Form Approved:

OMB No. 3206-0012

Attach all SF 171-A's to your application at the top of page 3.

1. Name (Last, First, Middle Initial)

2. Social Security Number