[Federal Register Volume 60, Number 163 (Wednesday, August 23, 1995)]
[Notices]
[Pages 43822-43825]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-20947]
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OFFICE OF PERSONNEL MANAGEMENT
Notice of Request for Approval of Application Form Submitted to
the Office of Management and Budget
AGENCY: President's Commission on White House Fellowships.
ACTION: Notice.
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SUMMARY: In accordance with the Paperwork Reduction Act of 1980 (44
U.S. Code, chapter 35), this notice announces a proposed revision of
the White House Fellowship Application which has been submitted to the
Office of Management and Budget for approval. This form is completed by
persons wishing to apply for a Fellowship. The information is used by
the Commission to evaluate an applicant's qualifications.
Approximately 1,000 applications are completed annually, requiring
an estimated five hours each, for a total annual burden of 5,000 hours.
Response is required to be considered for a Fellowship.
A copy of the proposal is appended to this Notice.
DATES: Comments on this proposal should be received within 10 calendar
days from the date of this publication. OMB has been requested to take
action within 10 calendar days.
ADDRESS: Send or deliver comments to Joseph Lackey, Desk Officer,
Office of Information and Regulatory Affairs, Office of Management and
Budget, New Executive Office Building NW., Room 10235, Washington, DC
20503, U.S. Office of Personnel Management.
Lorraine A. Green,
Deputy Director, Office of Personnel Management.
White House Fellowship Application
Instructions
Type all responses. Answer all questions fully and accurately, and
sign and date the application in the space provided in Question 4.
Questions 1-4 should be answered on the first two pages of the
application. (These pages may be recreated on a word processor,
however, the format must remain exactly the same.)
Be sure to carefully follow the directions for Question 5: it is
your receipt.
The remaining questions should be answered on separate sheets of
plain white 8\1/2\'' x 11'' paper. Each sheet should include your name,
social security number, and the question number in the upper right
corner.
You may include additional items with your application, such as
publications featuring or authored by you, books you have written, or
music you have recorded. Use your best judgment. Generally, unpublished
academic papers and copies of award certificates are not helpful.
Applications must be postmarked by December 1. It is the
responsibility of the applicant to ensure a package mailed on December
1 is postmarked with that date. Applications mailed from overseas
should be sent by air mail as early as possible. Mail applications to:
The President's Commission on White House Fellowships, 712 Jackson
Place, NW., Washington, DC 20503. While applications may be downloaded
electronically from the Internet, they may not be filed by e-mail. Only
hard-copy paper applications with original signatures will be accepted.
Applicants will be notified by mail that their application has been
received.
Only U.S. citizens are eligible to apply. Civilian employees of the
federal government are not eligible. The Commission cannot consider
applications from ineligible applicants, nor grant exemptions from
these requirements.
[[Page 43823]]
The federal government is an equal opportunity employer. Hiring is
based on qualifications and performance regardless of race, color,
creed, religion, sex, age, national origin, sexual orientation or
disability.
Application Checklist
First 2 pages of the application (Questions 1-4)
Cards requested in Question 5
Lists and essays (Questions 6-15)
Sealed recommendations (Question 16)
Part I
1. Personal Data
Name (last, first, middle)
Mr. Mrs. Ms. Other
Birthdate (mo/day/yr)
Other names used
Are you a US citizen: Yes No
Social Security Number
Occupation: (Profession, student, self-employed, retired, etc.)
Current employer's name and address:
Your title, rank, or status:
Home address:
Mailing address where you wish to receive Commission mailings, if
different from above:
Home phone:
Work phone:
Fax number:
E-mail address:
Have you ever worked for or are you now working for the federal
government, or are you being paid by federal funds? (Include active
duty military service.) If so, please explain below and give inclusive
dates.
Yes No
Explanation:
2. Personal Declarations
Please answer the following questions and explain on a separate
sheet of paper details and resolution of any question answered ``yes.''
Have you ever been discharged from the Armed Forces under other
than honorable conditions?
Yes No
Have you ever been convicted of a criminal offense?
Yes No
Have you ever been charged with a felony?
Yes No
Have you ever been charged with a violation of any firearms or
explosives laws?
Yes No
Have you ever failed to meet a court-ordered child support payment?
Yes No
Are you delinquent on any federal debt?
Yes No
Have you ever been suspended, disciplined, or barred from any
occupation or practice by any regulatory agency, professional
association or organization because of your conduct?
Yes No
3. References
In the space below, list the names and contact information for the
individuals whose personal evaluations accompany this application (see
Question 14). You may submit a minimum of 3 and a maximum of 5
recommendations for consideration.
Name-------------------------------------------------------------------
Address----------------------------------------------------------------
Phone------------------------------------------------------------------
4. Certification
I certify that all of the statements made in this application are
true, complete, and correct to the best of my knowledge and belief, and
are made in good faith. I know and understand that any or all items
contained herein may be reviewed by representatives of the Commission,
including former White House Fellows, and are subject to investigation
or verification and I consent to the full release of all information
concerning my capacity and fitness by employers, educational
institutions (who are authorized to release my academic records), law
enforcement agencies, and other individuals and agencies to duly
accredited investigators of the federal government or the Commission
for that purpose.
Signature (in ink)
Date-------------------------------------------------------------------
5. Required Cards
The following must be included with your application or it will not
be considered:
A typed 3'' x 5'' index card that lists on one side your name,
address, home and work phone numbers, date of birth, and date of our
application; and
A self-addressed, stamped postcard. This card will be mailed to you
as a receipt upon its arrival in the Commission office.
Part II
Instructions
The following questions should be answered on separate sheets of
paper. Type your name, social security number and question number in
the upper right corner of each page. Do not return or reproduce the
questions with your application; submit only your answers.
6. Career Summary
It is helpful for the Commissioners evaluating your application to
see ``at a glance'' the development of education and career patterns.
Therefore, on a separate sheet of paper under the heading, ``Career
Summary,'' please provide a chronological listing of all positions you
have held, beginning with the most recent. Include dates, employers
and/or schools attended. Account for all periods of unemployment.
Please limit your response to a maximum of one page; details can be
furnished in response to later questions.
Example:
6/92-present--Sr. Vice President, Acme Pictures
9/90-9/92--Director of Sales, Acme Pictures
6/90-9/90--Unemployed-job search
8/89-6/90--MBA student, Enormous State University
8/86-6/89--College student, Small State College
7. Educational Background
On a separate sheet of paper, type the heading ``Educational
Background'' and include the following. Generally, answers to this
question should not exceed one page.
A. Under the heading, ``Schools Attended,'' list all schools
attended, including high school. List the degree or diploma earned, the
name of each school, its location, dates attended and class rank.
Example:
MBA, Enormous State University, Anytown, USA, 8/89-8/90, top
quarter.
BS, engineering, Small State College, Anothertown, USA, 8/86-8/89,
school does not rank students.
B. If appropriate, under the heading, ``Tests and Exams,'' list all
tests and examinations required of you in order to quality for the
practice of any occupation or profession. For each test or examination,
list each time you took the test, the administrating agency, the state
or jurisdiction and year of such exam. For each test, also indicate
whether or not you passed or failed.
C. Under the heading, ``Activities,'' list all of the major
extracurricular activities in which you participated. Briefly explain
each one and list the level of your participation, including any
offices held, the length of your membership and the level of your
participation. Also list any major awards or recognitions received.
[[Page 43824]]
8. Work Experience
On a separate sheet of paper, type the heading ``Work Experience''
and list information about your employment history. Work back from your
current position and account for all periods of employment and
unemployment. Do not substitute a resume. You may use as many sheets as
required. Use the following as a guide:
Dates of employment
Exact job title
Employer
Employer's address and phone number
Nature of the business
Salary history
Number of workers you supervised
9. For each entry you may, at your option, provide a brief
narrative description of the work you performed, not to exceed 200
words for your current position and 100 words for all previous
positions. Describe any outstanding contributions made by you and list
any citations, awards, or unusual promotions.
Example:
6/92-present
Sr. Vice President
Acme Pictures, Inc.
1234 C Street, Anytown, USA 54321. (202) 555-1212
Videotape distributor
Paid $70,000/yr on 6/92; currently earn $80,000/year
Supervise 19 employees
10. Professional and Occupational Activities
On a separate sheet of paper, type of the heading, ``Professional
and Occupational Activities'' and list the major business and
professional activities in which you have participated during the past
ten years. Use the following guide:
Name of organization
City and state
Purpose or objective of the organization
Size of organization
Your level of participation
Dates of your participation
Awards or recognition you received for participation
Example:
The Generic Business Get-Together Group
Washington, DC
Professional advancement of business; lobbies Congress
2,000 nationwide
Co-founder; current vice president
8/93-present
No awards
11. Most Significant Achievement-Professional
On a separate sheet of paper, type the heading, ``Professional
Achievement'' and then describe in 200 words or fewer what you consider
to be your most significant contribution to your professional field. If
you exceed 200 words your application will be disqualified.
12. Most Significant Achievement-Community Service
On a separate sheet of paper, type the heading, ``Community Service
Achievement'' and then describe in 200 words or fewer what you consider
to be your most significant voluntary contribution to your community.
If you exceed 200 words your application will be disqualified.
13. Memorandum for the President
On a separate sheet of paper, type the heading, ``Memorandum for
the President'' and write a memorandum of not more than 500 words for
the President, making a specific policy proposal. Explain why you think
it is important, what issues it raises, and why you think the President
should support it. If you exceed 500 words your application will be
disqualified.
14. Lifetime Goals
On a separate sheet of paper, type the heading ``Lifetime Goals''
and describe in 300 words or fewer your life's ambition, what you hope
to accomplish or achieve in your lifetime, and what position you hope
to attain. If you exceed 300 words your application will be
disqualified.
15. Why I Want to be a White House Fellow
On a separate sheet of paper, type the heading, ``Why I Want to be
a White House Fellow'' and describe in 300 words or fewer why you want
to be a White House Fellow, what you consider to be your major
strengths and qualifications for the program, and what benefits you
feel are likely to result from your participation. If you exceed 300
words your application will be disqualified.
16. References
Please reproduce the enclosed personal evaluation letter and give
it to a minimum of 3 and a maximum of 5 people who know you well.
Recommenders should have a direct knowledge of your qualifications and
character. At least one person listed should have professional
competence in your field, at least one should have knowledge of your
major community or civic activities, at least one should have knowledge
of your business or professional accomplishments, and at least one
should be your present supervisor, if applicable. Each reference should
seal the letter of recommendation in an envelope, sign his or her name
across the seal, and return the form to you. These references must be
included in your application. Your application cannot be considered
without these references.
White House Fellowship Application Candidate Evaluation
To: Individuals Completing an Evaluation
Subject: (Applicant's name)
From: The President's Commission on White House Fellowships
Thank you for taking the time to write a recommendation for the
White House Fellowship applicant named above. Your candid and specific
responses to the questions below will help the President's Commission
select the next class of Fellows, 11 to 19 individuals from across the
nation who will come to Washington to work for one year as paid, full-
time special assistants to Cabinet officers and senior White House
officials.
Please answer the following questions (on your office letterhead,
if appropriate) and include your daytime telephone number. Please sign
your evaluation, place it in a sealed envelope, write your signature
over the seal, and return it to the applicant. The applicant must
submit your evaluation as part of his or her application.
1. How long and in what connection have you known the applicant?
2. What are the applicant's major strengths? Please relate an occasion
in which these strengths were demonstrated.
3. What are the applicant's major weaknesses?
4. What impact has the applicant had on his/her professional field?
5. What impact has he/she had in the community, outside the applicant's
professional realm?
6. What has the candidate done that you consider creative?
7. How would you rate this candidate's writing ability?
8. How would you rate this candidate's intellectual ability?
9. How would you rate this candidate's public speaking ability?
10. How would you rate this candidate's personal integrity?
11. How would your rate this candidate's consensus-building,
negotiating and leadership skills?
[[Page 43825]]
12. If you were a Cabinet Secretary, would you hire this person to be a
key member of your staff?
13. What would you expect this candidate to be doing in 15 to 20 years?
Privacy Act and Paperwork Reduction Act Statements
Pursuant to the Freedom of Information Act (5 U.S.C. 552, as
amended) and the Privacy Act (5 U.S.C. 552a), the President's
Commission on White House Fellowships operates its competitive
application process and collects personal information for its use in
evaluating applicants under authority of Executive Order 11183, as
amended. Submission of the information is voluntary; however,
failure to furnish all the requested information may result in delay
or elimination of consideration for a Fellowship. All files,
records, and other material submitted by or in behalf of any
applicant, or collected or obtained with regard to an applicant, are
used by those persons associated with the Commission for the purpose
of screening and evaluating applications. The information may also
be disclosed to a congressional office in response to an inquiry
from that office made at the request of that individual. Executive
Order 9397 provides for the collection of Social Security Numbers to
identify individual records. Furnishing your Social Security Number
is voluntary; however, failure to do so may delay the processing of
your application.
This request is in accordance with the clearance requirements of
the Paperwork Reduction Act (44 U.S.C. 3507). The information is
being collected in order to evaluate your qualifications for a
Fellowship. Your response is required to make this determination.
Public reporting burden for this collection of information is
estimated to average five (5) hours per response, including time for
reviewing instructions, gathering the requested personal
evaluations, and completing the application. Please send comments
regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing the
burden, to the President's Commission on White House Fellowships,
Washington, DC 20415.
Records Retention
The application forms of persons selected as White House Fellows
may be circulated to appropriate Executive Branch officials incident
to placing Fellows in assignments for the Fellowship year and
subsequently may be retained, along with other applicant file
materials, by the Commission in its permanent files on persons who
are selected as White House Fellows. These permanent records are
accessible to the individuals concerned.
Sixty days after a letter has been mailed to an applicant
advising that he or she has been eliminated from the competition,
all materials in the applicant's file will be destroyed and this
procedure will be repeated after each stage of the selection
process.
The Commission cannot assume responsibility for the return of
applications or supporting documents. Applicants are therefore
advised to retain copies of their application forms and not to
submit irreplaceable documents or other materials with applications.
[FR Doc. 95-20947 Filed 8-22-95; 8:45 am]
BILLING CODE 6325-01-M
