Fillable Printable Personal Data Statement
Fillable Printable Personal Data Statement
Personal Data Statement
PERSONAL DATA
STATEMENT
NAME (Last, first, middle initial)
FIRST SUBMISSION
OF THIS FORM
UPDATE (Complete only those items for
which you have new or changed data)
Check
one
If your last name has changed
since last submission,
give previous last name.
YOUR
PRESENT
POSITION
YOUR
PRESENT
WORK
LOCATION
OFFICE MAILING
SYMBOL
SERIES
GRADE
C.O.
TITLE
SERVICE OR STAFF OFFICE, DIVISION AND BRANCH
PRIVACY ACT INFORMATION
In compliance with the Privacy Act of 1974 the
following information is provided; Under authority
of 5 USC 4103, the Civil Service Commission
allows agencies to establish and operate training
programs. The information you provide will be
used by managers, supervisors and
personnelists in career counseling and planning.
This information is also used to monitor and
document the performance and status of GSA
career development programs. This form
becomes a part of your career folder and
contains vital information concerning your
employment background, training and career
objectives. The routine uses of the form as
defined in 5 USC 552(a)(7) and provided for in
552a(b)(3) are described in the Appendix
following the GSA notice published in the Federal
Register. Copies of the Appendix may be
obtained from any GSA personnel office.
Disclosure of the information on this form by you
is voluntary; however, if all appropriate
information is not provided, proper career
counseling and planning will not be possible.
CITY AND STATE
If more space is required for any section, use full sheets of paper and indicate section to which data applies.
SPECIFICALLY IDENTIFY THE POSITION OR POSITIONS WHICH ARE YOUR CAREER OBJECTIVES
AVAILABILITY FOR DEVELOPMENTAL ASSIGNMENTS AND OR PROMOTIONS
EMPLOYMENT DATES
POSITION TITLE OR TYPE OF WORK
(If applicable show highest grade)
ORGANIZATION
FROM
SPECIAL SKILLS YOU POSSESS AND ANY MACHINES, EQUIPMENT, SCIENTIFIC OR PROFESSIONAL DEVICES YOU CAN USE
GENERAL SERVICES ADMINISTRATION
GSA FORM 1349 (REV. 8-76)
TO
SECTION I - WORK EXPERIENCE
(Begin with job prior to present one. Include significant detail assignments and military service.)
SECTION II - SPECIAL QUALIFICATIONS, SKILLS AND ACTIVITIES
Check
appropriate
box(es)
IN PRESENT
COMMUTING AREA
OUTSIDE
PRESENT AREA
Specify
location
REGION NO.
CHIEF COLLEGE GRADUATE COURSES
GSA FORM 1349 BACK (REV. 8-76)
GENERAL SERVICES ADMINISTRATION
SECTION V - REMARKS OR OTHER INFORMATION
I certify that the statements made by me above
are true, complete and correct to the best of my
knowledge and belief, and are made in good faith.
SECTION II - SPECIAL QUALIFICATIONS, SKILLS AND ACTIVITIES, Continued
SECTION III - EDUCATION
SECTION IV - TRAINING
Include schools not shown above, and training such as government, business, trade, vocational, Armed Forces, etc.
SPECIAL QUALIFICATIONS (Your more important publications, patents and inventions, public speaking and public relations experience; membership in professional or scientific
societies and offices held; or honors, fellowships and awards)
SPECIAL ACTIVITIES NOT SHOWN ELSEWHERE (Such as boards, commissions, special committees, etc. that you have served on in connection with you work, either in GSA or
elsewhere; major community activities, volunteer work, and offices held; or hobbies)
LICENSES AND
CERTIFICATES
CURRENTLY IN
EFFECT
HIGH SCHOOL
(Check highest
year completed)
1ST
3RD
G.E.D.
2ND
4TH
TYPE
COLLEGE OR UNIVERSITY
CHIEF COLLEGE UNDERGRADUATE COURSES
COURSE TITLE
ORGANIZATION WHICH
CONDUCTED TRAINING
DATES ATTENDED
COURSE COMPLETED
FROM
TO YES NO
NO. OF
CLASSROOM
HOURS
SEMESTER
HOURS
QUARTER
HOURS
SEMESTER
HOURS
QUARTER
HOURS
DATES ATTENDED
SEMESTER
CREDITS
QUARTER
CREDITS
TYPE OF DEGREE
AND MAJOR
FROM TO
STATE OR OTHER GRANTING AUTHORITY
EMPLOYEE
Sign
here
DATE
