USA Staffing

The following section is used to determine your eligibility for appointment in the Federal Government/your eligibility for referral consideration. Please select the most appropriate response to the following questions. Failure to claim at least one eligibility will result in an ineligible rating. Applicants are responsible for claiming their appropriate eligibility/eligibilities. We are not responsible for erroneous eligibilities that you list or those you fail to list. NOTE: If you are going to be submitting your answers to the occupational questionnaire by manually completing the 1203FX form, to provide your responses to the occupational questionnaire, record your responses in section 25 starting with question 1 and complete the remaining answers in successive order.

Select “Yes” or “No” to the following question(s).

1. Are you currently a career or career-conditional employee of the facility in which this vacancy is offered? (If so, please include a copy of your most recent Notification of Personnel Action SF-50 that has item 24 showing 1 or 2).

A. Yes

B. No

2. Are you currently a career or career conditional employee of the Department of Veterans Affairs (VA)? (If yes, please include a copy of your most recent Notification of Personnel Action, SF-50, that has Item 24 showing 1 or 2).

A. Yes

B. No

3. Are you currently a federal employee employed at another agency (other than the Department of Veteran Affairs)? (If so, please include a copy of your most recent Notification of Personnel Action, SF-50, that has Items 24 showing as 1 or 2 and 34 showing as 1 or 2. For the applicants that have 2 showing for item 34, please refer to the OPM Interchange Agreement to determine consideration of competitive eligibility OPM Interchange Agreement.

A. Yes

B. No

4. Are you are a former federal employee with reinstatement eligibility? To be eligible for reinstatement, you must have been served in a career appointment, or served in a career-conditional appointment within the past three years. (If so, please include a copy of your last Notification of Personnel Action, SF-50, that has Item 24 showing as 1 or 2. For additional information, please refer to OPM Reinstatement Hiring Information OPM Reinstatement.

A. Yes

B. No

5. Are you eligible for an appointment as a 30% or more compensable disabled Veteran? To be eligible, you 1) must have retired from active military service with a service-connected disability rating of 30% or more, or 2) have a rating by the Department of Veterans Affairs showing a compensable service-connected disability of 30% or more. (If so, please include your Member 4 DD 214 and your VA Disability letter which will include your disability rating %).

A. Yes

B. No

6. Are you eligible for a Veterans Recruitment (VRA) Appointment? To be eligible, you a) must have been separated under honorable conditions (this means an honorable or general discharge). Also, you must be: 1) a disabled Veteran, or 2) a Veteran who served on active duty in the Armed Forces during a war, or in a campaign or expedition for which a campaign badge has been authorized (you must have received the campaign badge or medal, or 3) a Veteran who, while serving on active duty in the Armed Forces, participated in a United States military operation for which you received an Armed Forces Service Medal, or 4) a recently separated Veteran (separated within the past three years). (If so, please provide your Member 4 DD 214 or other proof of your service).

A. Yes

B. No

7. Are you eligible for a Veterans Employment Opportunity Act (VEOA) Appointment? To be eligible, you must have 1) Veterans preference or 2) are a Veteran separated after substantially completing at least three (3) years of continuous active duty service performed under honorable conditions (this means an honorable or general discharge). (If so, please provide your Member 4 DD 214 other proof of service. For additional information, please refer to Feds Hire Vets.

A. Yes

B. No

8. Do you have a disability that substantially limits one (1) or more major life activities? To be eligible, you 1) must have a severe physical, cognitive or emotional disability, 2) have a history of having such disability, or 3) be perceived as having such disability. (If so, please provide your certification letter from a State Vocational Rehabilitation Office, the Department of Veterans Affairs, or your Medical Professional).

A. Yes

B. No

9. Are you eligible for some other noncompetitive appointment (Special Hiring Authority)? This includes appointment based on an interchange agreement, eligibility of some military spouses/parents, or similar authorities. Please visit OPM Appointment Authorities to see information about interchange agreements and other noncompetitive appointments. MILITARY SPOUSES: please visit Feds Hire Vets.

A. Yes

B. No

Please select the appropriate answer to each of the following questions based on your knowledge, skill or ability to perform the duties of this position. When answering the questionnaire, remember that your answers are subject to verification by investigation. You may be asked to provide specific examples or documentation of your knowledge or skills as proof to support your answers, or you may be required to verify a response by a practical demonstration of your claimed ability to perform a task.

Select “Yes” or “No” to the following question(s).

10. Do you have knowledge of modified diet principles, patient preference and additional order substitutes?

A. Yes

B. No

Select the one statement that most accurately describes your training and experience carrying out each task using the scale provided.

11. Knowledge of work practices, cleanliness, neatness and sanitation in food service work.

A. I know little or nothing about this.

B. I have had study or training in this.

C. I have used my knowledge or ability, but I have been closely supervised.

D. I have used my knowledge or ability on my own, under normal supervision.

E. I am consulted by other journeypersons in difficult situations, or I am called on to do unusually difficult jobs.

12. Ability to read, understand and follow written and oral instructions, policies and procedures relating to food preparation and serving work.

A. I do not have any experience in keeping work areas, equipment and materials clean, sanitary, neat and in order.

B. I have little or some experience in keeping work areas, equipment and materials clean, sanitary, neat and in order.

C. I am able to keep work areas, equipment and materials clean, sanitary, neat and in order with help from an experienced employee.

D. I do not require immediate supervision when keeping work areas, equipment and materials clean, sanitary, neat and in order.

E. I am independently able to keep work areas, equipment and materials clean, sanitary, neat and in order.

13. Knowledge of technical practices in food service work such as dietary computer programs and reports, checking trays, and food service temperature and requisitioning.

A. I know little or nothing about this.

B. I have had study or training in this.

C. I have used my knowledge or ability, but I have been closely supervised.

D. I have used my knowledge or ability on my own, under normal supervision.

E. I am consulted by other journeypersons in difficult situations, or I am called on to do unusually difficult jobs.

Certification of Understanding - Select the appropriate answer to the statement below. Failure to provide an answer will result in your not being considered for this position.

14. I certify that, to the best of my knowledge and belief, all of the information included in this questionnaire is true, correct, and provided in good faith. I understand that if I make an intentional false statement, or commit deception or fraud in this application and its supporting materials, or in any document or interview associated with the examination process, I may be fined or imprisoned (18 U.S.C. 1001); my eligibilities may be cancelled; I may be denied an appointment; or I may be removed and debarred from Federal service (5 C.F.R. part 731). I understand that any information I give may be investigated and that responding "No" or providing no response to this item will result in my not being considered for this position.

A. Yes, I understand the information provided above and certify that the information provided in this questionnaire is true, correct and provided in good faith.

B. No, I do not certify this information and do not wish to be considered for this position.

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