ContractAuthorization, Agreement and Certification of Training • August 8th, 2007
Contract Type FiledAugust 8th, 2007AUTHORIZATION, AGREEMENT AND CERTIFICATION OF TRAINING A. Agency, code agency subelement and submitting office number B. Request Status (Mark (X) one)Resubmission InitialCorrection Cancellation Section A - TRAINEE INFORMATIONPlease read instructions on page 6 before completing this form 1. Applicant's Name (Last, First, Middle Initial) 2.Social Security Number/Federal Employee Number 3. Date of Birth (yyyy-mm-dd) 4. Home Address (Number, Street, City, State, ZIP Code) (Optional) 5. Home Telephone (Optional) (Include Area Code) 6. Position Level (Mark (X) one) ✖ a. Non-supervisory b. Manager c. Supervisory d. Executive 7. Organization Mailing Address (Branch-Division/Office/Bureau/Agency)) 8. OfficeTelephone(Include Area Code and Extension) 9. Work Email Address 10. Position Title 11. Does applicant need special accomodation?Yes ✖ No If yes, please describe below 12. Type of Appointment 13. Education Level(click link to view codes or go to page 7) 14. Pay Plan 15. Series 16. Grade 17