Fillable Printable Employment Application DC2000 - The District of Columbia
Fillable Printable Employment Application DC2000 - The District of Columbia
Employment Application DC2000 - The District of Columbia
3. D.C. EMPLOYMENT HISTORY AND AVAILABILITY
1. POSITION VACANCY INFORMATION
Street Address
City
Last Name First Name Middle Name
Zip CodeState
Apt #
Ward
Home Phone
Email
Other names ever used
Social Security Number
Date of Birth
Position Title
Vacancy Announcement No
Business Phone
Yes
No
Yes
No
Yes
No
Yes
No
2. PERSONAL DATA
4. RESIDENCY
DISTRICT OF COLUMBIA GOVERNMENT
EMPLOYMENT APPLICATION (DC2000)
Please answer the questions and complete all required fields on this application. In addition, please respond to all of the
ranking factors listed in the vacancy announcement. Finally, if you are claiming residency preference, please complete
the residency preference form.
a. Are you now or were you ever employed by the District of Columbia Government?
When can you start work?
Lowest pay or grade you will accept
Grade Series Stepc. List highest grade, classification series and step attained:
b. Mark below each type of current or previous D.C. government appointment. Check all applicable boxes.
Temporary Term Permanent
Career
Excepted Service
Executive Service
OtherManagement Supervisory Service Legal Service
If the position you are applying for above is in the Career Service, Management Supervisory Service, or
Legal Service, excluding the Senior Executive Attorney Services, are you claiming a residence
preference? (If you claim residency preference, you must complete the Residency Preference for
Employment form, DC-2000RP).
c.
b. I understand the residency preference requirements (found at the end of this document).
a. Are you claiming a residency preference for the position indicated above?
If the position you are applying for above is in the Excepted Service, Executive Service, or Senior
Executive Attorney Service, do you acknowledge and understand that, if selected, you must be a
domiciliary of the District of Columbia at the time of the appointment or within 180 days of the
appointment date, and maintain District domicile for the duration of the appointment?
d.
Rev. 5/14
6. EDUCATION
5. MILITARY SERVICE AND VETERANS PREFERENCE
b. Colleges and Universities
From
To
Dates of Active Duty Service (Month/Day/Year)
Separation Date
Character of Separation
Campaign or Expeditionary Medals Received
Preference claimed
:
(Please check one. You must show proof when hired.)
5-point preference 10-point preference None
Have you ever served on active duty in the United States Armed Forces?
Did you or will you retire at or above the rank of Major or Lieutenant Commander?
(Answer "NO" if your only active duty was for training, including basic training, in the Reserves and National Guard)
(If "YES," you are not eligible for veterans preference unless your retirement is based upon a service-
connected disability.)
Veterans preference is granted by law to disabled veterans, to veterans who served on active duty in certain time periods
or military operations, and, under certain conditions, to the spouses, widows, widowers, or mothers of deceased or
disabled veterans.
Indicate highest grade completed:
Address of School:
Zip Code
Attended From
To
Did you graduate? If no, have you received a GED high school equivalency?
Indicate highest degree(s) obtained (e.g., A.A., B.S):
Address of College or University
Zip Code
Major
Minor
Major Semester Credit Hours OR Major Quarter Credit Hours
Attended From
Indicate highest degree(s) obtained (e.g., A.A., B.S):
Address of College or University
Zip Code
Major Minor
Major Semester Credit Hours OR Major Quarter Credit Hours
Attended From
School 1
School 2
a. High School:
Yes
No
Yes
No
Yes
No
Yes
No
(month/year)
(month/year)
(month/year)
To
(month/year)
(month/year)To
(month/year)
9. WORK EXPERIENCE
List paid or unpaid work experience relevant to the position for which you are applying. (Note: If additional space is needed,
continue on a separate sheet of paper).
PRESENT OR MOST RELEVANT POSITION:
Employer's Name
Dates of Employment
(Month/Year)
From
To
Annual Salary
Starting $
Final $
Address
Name and Title of SupervisorTelephone
Reason for leaving
No. of Employees Supervised
If District or Federal Employment, List Series, Grade or Rank and Date of Last Promotion
Job Title and Duties, Responsibilities and Accomplishments
No Work Experience
List relevant training, licenses or skills (e.g., sign language). Include schools attended, addresses, certificates or
degrees awarded, dates attended, number of credit hours, and major/minor field or subjects studied.
8. LANGUAGE CAPABILITIES
7. TRAINING
Language Speak
Read
Write
List the languages you speak, read and write
Average
Hours
Per Week
POSITION:
Employer's Name Dates of Employment
(Month/Year)
From To
Annual Salary
Starting $
Final $
Average
Hours
Per Week
Address
Telephone Name and Title of Supervisor
Reason for leaving
No. of Employees Supervised
If District or Federal Employment, List Series, Grade or Rank and Date of Last
Promotion
Job Title and Duties, Responsibilities and Accomplishments
POSITION:
Employer's Name Dates of Employment
(Month/Year)
From To
Annual Salary
Starting $
Final $
Average
Hours
Per Week
Address
Telephone Name and Title of Supervisor
Reason for leaving
No. of Employees Supervised
If District or Federal Employment, List Series, Grade or Rank and Date of Last Promotion
Job Title and Duties, Responsibilities and Accomplishments
POSITION:
Employer's Name
Dates of Employment
(Month/Year)
From To
Annual Salary
Starting $
Final $
Average
Hours
Per Week
Address
Telephone Name and Title of Supervisor
Reason for leaving
No. of Employees Supervised
If District or Federal Employment, List Series, Grade or Rank and Date of Last
Promotion
Job Title and Duties, Responsibilities and Accomplishments
POSITION:
Employer's Name
Dates of Employment
(Month/Year)
From To
Annual Salary
Starting $
Final $
Average
Hours
Per Week
Address
Telephone Name and Title of Supervisor
Reason for leaving
No. of Employees Supervised
If District or Federal Employment, List Series, Grade or Rank and Date of Last
Promotion
Job Title and Duties, Responsibilities and Accomplishments
To
a.
If “YES,” in the space below, write, for each of these relatives, their (1) name; (2) relationship to you;
and (3) District agency in which the relative works.
Name*
Relationship District Agency
(*Note: If more than five (5) relatives continue on a separate sheet of paper.)
b. Do you receive or have you ever applied for retirement pay, pension, or other pay based on District of
Columbia government, federal civilian or federal military service.
c. Are you a citizen of the United States?
d. Are you legally authorized to work in the United States?
To work for the District of Columbia government in certain public safety positions, you must be a citizen
of the United States. If selected, you will be required to submit evidence of identity and employment eligibility.
10. BACKGROUND INFORMATION
Do any of your relatives work for the District of Columbia government? Include: father, mother, husband,
wife, son, daughter, brother, sister, uncle, aunt, first cousin, niece, nephew, father-in-law, mother-in-law,
daughter-in-law; brother-in-law; sister-in-law; stepfather; stepmother; stepdaughter; stepbrother; half-
brother; and half-sister.
Yes
No
Yes
No
Yes
No
Yes
No
Ranking Factor 1
Ranking Factor 2
The ranking factors found in the vacancy announcement will be used in the evaluation process for all positions other
than wage grade. All applicants MUST respond to the ranking factors. Please describe specific incidents of sustained
achievements from your experience that show evidence of the level at which you meet the ranking factors that have
been determined to be of importance for the position for which you are applying. You may refer to any experience,
education, training, awards, outside activities, etc. that include the degree to which you possess the job related
knowledge, skills, and abilities described in the ranking factors. The information given in response to the ranking factors
should be complete and accurate to the best of your knowledge. FAILURE TO RESPOND TO ALL RANKING
FACTORS MAY ELIMINATE YOU FROM CONSIDERATION.
Use the spaces below to respond to the ranking factors on the job vacancy announcement.
11. RANKING FACTORS
Ranking Factor 3
Ranking Factor 4
DISTRICT OF COLUMBIA GOVERNMENT
When answering the question below, you may omit: (1) traffic fines; (2) any violation of law committed before your
18th birthday, if handled in juvenile court or under a youth offender law; (3) any violation set aside under the Federal
Youth Corrections Act or similar state law; and (4) any conviction for which the record was expunged under federal,
state, or local law. We will consider the date, facts, and circumstances of each conviction or forfeiture you list. In most
cases, you can still be considered for District employment.
During the past 10 years, have you been: (1) convicted of or forfeited collateral for any felony; or (2)
convicted by a court-martial?
A
felony
is defined as any violation of law punishable by imprisonment of longer than one year, but does not include
a
misdemeanor
under state, county, or local law, punishable by imprisonment of two years or less.
If you answered
“YES”
to the QUESTION above, you are allowed an opportunity to explain your response. For
each of your conviction(s), please state the following: (1) offense(s) of which you were convicted; (2) the date of
the conviction(s); (3) the state or territory where the conviction(s) occurred; (4) the court; and (5) any action(s)
taken by the court against you, including any sentence, or probation imposed. Please provide any additional
explanation you would like us to consider.
By clicking the check box below, I understand that a false statement on any part of my application may be grounds for not hiring me, or
for firing me after I begin work (D.C. Official Code § 1-616.51, et seq) (2001). I understand that the making of a false statement on this
form or materials submitted with this form is punishable by criminal penalties pursuant to D.C. Official Code § 22-2405, et seq. (2001).
I understand that any information I give may be investigated as allowed by law or Mayoral Order. I consent to the release of information
regarding my suitability for District of Columbia Government employment by employers, schools, law enforcement agencies, and
other individual or organizations, to investigators, personnel staffing specialists, and other authorized employees of the District of
Columbia government. I certify that, to the best of my knowledge
and belief, all my statements are true, correct, and complete.
13. SIGNATURE,
CERTIFICATION
,
AND RELEASE OF INFORMATION
I have read and understand the above information and certify that the information that I have provided herein is true and accurate.
If you chose to "Print form", please sign and date.
Yes
No
Applicant’s Signature
Date (Month, Day, Year)
12. CRIMINAL HISTORY DISCLOSURE INFORMATION
