Bc 170A – Fill Out and Use

TYPES OF WORK

Data Collection: The majority of available positions at the Census Bureau involve data collection. Data collection involves working from home and interacting with the public. These jobs could involve the following tasks: knocking on doors to collect personal information and verifying household address listings. These jobs almost certainly require you to work nights, weekends, and whenever respondents are available. Limited data collection supervisory positions are also available for the Decennial Census and Special Census programs.

Outreach: These positions are only available for the Decennial Census program. These positions involve outreach to Census partners and potential applicants for Census jobs. Outreach work is conducted outside an office environment.

Office: For applicants who live close to one of the limited number of Census Bureau offices, there are a few office positions available. Office duties include a variety of clerical support tasks such as file maintenance, data entry, answering/making phone calls, word processing, shipping and receiving, processing payroll and personnel actions, and other administrative operations. Limited office supervisory positions are also available for the Decennial Census and Special Census programs.

CONFIDENTIALITY REQUIREMENT

If you are hired, the information you collect from the public will be confidential and must NOT be disclosed to anyone who has not been sworn in to protect Census Bureau information.

DURATION OF WORK

Short-term: Most positions are short-term and generally last several weeks.

Long-term: There are a limited number of long-term positions. Long-term positions vary in length, but could extend several weeks, months, or years, depending on the survey work available. Applicants who are selected for long-term positions will be notified of the duration during the interview.

TRAINING

If selected, you may be asked to attend a paid training session. You may be asked to travel for training and will be reimbursed. Certain positions may require you to complete automated self-studies online and/or classroom training that may require travel to another city on government per diem for several days, including overnight travel. Other positions may require on-the-job training, as well as refresher training sessions periodically.

PAY

Social Security deductions will be taken from your earnings. Federal, state, and local income taxes, where applicable, also will be deducted. You will be reimbursed for authorized out of pocket expenses, telephone, and other travel costs, such as parking fees, bus fares, etc., while on official business travel. If hired, you will receive specific information about pay from a Census representative.

Am I eligible for Census work?

1.You must be a United States citizen.

2.You must be 18 years old or older.

3.You must have a valid Social Security Number.

4.You must have a valid e-mail address. Any questions or issues with your application will be communicated via this email or by text message if provided. All job interviews and job offers will be conducted via the phone numbers you have provided.

5.You must answer assessment questions. For some positions, the assessment questions may be available in Spanish; however, an English Proficiency Test may also be required.

6.Male applicants born after December 31, 1959, must be registered with the Selective Service System.

7.You must pass a Census Bureau performed criminal background check and review of criminal records (including fingerprinting) as part of the hiring process.

8.You may not engage in any partisan political activity while on duty.

9.Your current employment (including law and regulatory enforcement jobs) will be reviewed on a case-by-case basis for compatibility with Census Bureau employment.

10.Since not all people will be home during the day, you must be available to work days, evenings, and/or weekends. Visits will usually be no later than 9:00 p.m. You generally will have flexibility to choose which hours to work during these productive time periods.

How do I complete the BC-170, U.S. Census Employment Application?

2.Follow the instructions provided with every item. If you do not answer all questions fully and correctly, you may delay the processing of your application.

3.Enter one letter or number within each white block or complete the information on the line provided.

Below are a few explanatory notes for some of the items:

Section A – Applicant Profile

Item 3. Enter your street address followed by your city, county, state and ZIP code. Enter the State postal abbreviation for the state in which you live, for example, MS for Mississippi.

Item 6. Enter your e-mail address. E-mail is the primary way you will receive information, should you be offered a position.

Item 7. Enter your contact number(s) in the appropriate fields, and Mark (X) if Mobile.

Item 9a. Enter your Date of Birth. For example, enter July 6, 1952 as follows:

The Application Process (Next Steps)

The application process includes the following forms:

1.BC-170 – U.S. Census Employment Application

2.BC-171 – Additional Applicant Information

All applicants will be required to answer assessment questions.

What are the assessment questions like?

The assessment questions are designed to indicate your fit for a variety of Census jobs. By submitting one application and answering a basic set of assessment questions, you may be considered for several positions. The assessment is physically accessible to people with disabilities. If you need a reasonable accommodation for any part of the application and hiring process, please find the information listed in the box below.

Privacy Act and Burden Statement

Solicitation of your personal information is authorized by Title 13 U.S.C., Chapter 1, Subchapter II, Section 23a and c; Title 5 U.S.C., Part II, Chapter 13; Title 5 U.S.C., Part III, Chapter 33, Subchapter 1, Section 1 and 20; and Executive Orders 9397, 10566.

The purpose of collecting this information is primarily to determine your qualifications for employment and may also be used to identify you to other sources asked to comment on your qualifications, e.g. educational institutions, former employers, and enforcement agencies, or to a court during legal proceedings. Personal information collected includes your Social Security Number (SSN), name, address, date of birth, telephone number, etc.

Disclosure of the information provided to us may be shared with other Census Bureau staff for the work-related purposes identified in this statement as permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a). Disclosure of this information is also subject to the published routine uses as identified in the Privacy Act System of Record Notice OPM/GOVT-5, Recruiting, Examining, and Placement Records.

Furnishing this information is voluntary, but failure to provide any part or all of the data requested will result in you receiving no further consideration for employment.

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Reduction Project 0607-0139, Field Division Correspondence Liaison, U.S. Census Bureau, 4600 Silver Hill Road, 5th Floor, Washington, DC 20233-1500. You may E-mail comments to FLD.Decennial.Oversight@census.gov; use "Paperwork Reduction Project 0607-0139" as the subject.

The eight digit OMB number on page 3 of this form confirms our authority to collect this information.

For more information, contact:

10a. Are you a citizen or national of the United States?

Yes –SKIP to Item 11.

No – Provide country of citizenship. C

b.Are you a lawful permanent resident of the United States?

Yes – Specify Alien Registration No./USCIS No. C

No

11.FOR MALES ONLY: If you are a male born after December 31, 1959, and you want to be employed by the Federal Government, you must be registered with the Selective Service System. Mark (X) in one box only.

I certify that I am registered – Please enter your number below. C

Selective Service Number

I certify that I am not registered. Please provide explanation in Section D or attach documentation of exemption.

Note: To find your Selective Service Number, please visit the Selective

Service website: https://www.sss.gov. If you would like to submit a paper copy of your supporting documentation for selective service exemption, please contact the office noted on the cover page of this form.

12.Military Service

a.Do you claim veterans’ preference? Mark (X) in one box only.

No preference – SKIP to Item 13.

Yes

b.Veterans’ preference categories? Mark (X) in one box only.

5-point. Veteran is entitled to 5-point preference. (TP)

10-point/Disability. Veteran is entitled to 10-point preference due to a service-connected disability (includes recipient of the Purple Heart who is not rated as having a compensable disability of 10 percent or more). (XP)

10-point/Compensable. A veteran who served at any time and who has a compensable service-connected disability rating of at least 10 percent but less than 30 percent. (CP)

10-point/Other. Persons entitled to 10-point preference in this category: (1) Both the spouse and mother of a veteran occupationally disabled because of a service-connected disability; and (2) the widow/widower and mother of a deceased wartime veteran. (XP)

10-point/Compensable/30 Percent. Veteran is entitled to

10-point preference due to a compensable service-connected disability of 30 percent or more. (CPS)

Sole Survivorship Preference Eligible. No points awarded. A service member who is released or discharged from the Armed Forces after August 29, 2008, at the request of the member who is the only surviving child in a family in which the father or mother or one or more siblings

(1)served in the Armed Forces; (2) was killed, died as a result of wounds, accident, disease, is in a captured or missing in action status, or is permanently 100 percent disabled or hospitalized on a continuing basis (and is not employed gainfully because of the disability or hospitalization); and (3) death, status, or disability did not result from the intentional misconduct or willful neglect of the parent or sibling and was not incurred during a period of unauthorized absence. (SSP)

Military Service – Continued

Note: For more information and/or to determine if you are eligible for Veteran’s Preference, please visit https://www.fedshirevets.gov/job/vetpref/index.aspx. You must provide acceptable documentation of your preference or appointment eligibility. Acceptable documentation includes:

•A copy of your DD-214, "Certificate of Release or Discharge from Active Duty," which shows dates of service and discharge under honorable conditions.

•A "certification" that is a written document from the Armed Forces that certifies the service member is expected to be discharged or released from active duty service in the Armed Forces under honorable conditions no later than 120 days after the date the certification was signed.

•If you claim 10 point preference or sole survivorship, you must complete a Standard Form 15 (SF-15), which is available online or at any Federal Job Information Center. Submit a complete SF-15 and include the applicable documentation required (listed on page 2 of the SF-15).

•A letter from the Department of Veterans Affairs reflecting your level of disability for preference eligibility.

Note: You may submit your application prior to providing the necessary Veterans’ Preference supporting documentation. If you need to submit paper copies of your documentation for Veterans’ Preference, please contact the office noted on the cover page of this form. Please note that you will not receive additional points until we verify your provided documentation.

Section B – GOVERNMENT EMPLOYMENT HISTORY

13.Have you ever worked for the Census Bureau?

Yes – Indicate most recent title and dates of employment. C

Title

TO

No

14.Are you currently employed by a Federal government agency?

Yes – Indicate hire date, agency and title. C

Hire Date

Month Year

AgencyTitle

No

15.Are you currently employed by a state, local or tribal government agency?

Yes – Indicate current title and agency. C

No

16.Are you currently an elected official of any government agency?

Yes – Indicate current title and agency. C

No

17.Are you currently employed by a law enforcement agency?

Yes – Indicate current title and agency. C

No

18.Are you a retiree receiving a Federal annuity? If you are an annuitant, your salary or annuity may be reduced upon employment. Social Security payments are NOT considered a Federal annuity.

Yes – Indicate the agency and explain in Section D. C

No

19.Have you worked for the Federal government or military and received a Voluntary Separation Incentive Payment (VSIP) or "Buyout" within the past 5 years?

The majority of individuals who accept re-employment with the Federal government within 5 years of receiving the VSIP/buyout amount must repay the gross amount of the separation pay prior to reemployment.

I have NOT received a VSIP/Buyout from a prior Federal appointment within the past 5 years.

I have received a VSIP/Buyout from a prior Federal appointment within the past 5 years. I understand that I must repay the full amount before I may be reappointed.

If paid in full, you must provide proof of payment.

Indicate VSIP/buyout Year

Agency

20.Do any of your relatives currently work for the Census Bureau? Include – Parents, spouse, children, grandparents, siblings (include half), aunts, uncles, first cousins, nephews, nieces, in-laws and step relatives.

Yes – If yes, indicate relationship, current title, first/last name and location. C

Section C – LANGUAGE SKILLS AND AVAILABILITY

21.Some Census Bureau jobs require employees to conduct the Census interview by reading and recording responses to questions in a language other than English. The employee must be able to convince individuals who speak no English to respond to the interview by explaining the purpose and importance of the census. Employees will receive Census job-related training, but not language training.

Are you fluent in any language where you can hold a conversation, read and record responses, and respond to questions in that language? If so, indicate the language(s) below and mark (X) to all that apply.

Fluent

Please include American Sign Language.

If you need to add additional languages continue in Section D.

22.Indicate the type(s) of transportation available for your use – Mark (X) ALL that apply.

Automobile

Check if 4-Wheel Drive

Airplane

Boat

ATV (All terrain vehicle)

Other – Describe C

None

23a. When are you available to work? Census field work will usually require you to work evenings and weekends. Some positions will require shift work. Hiring for some positions is based, in part, on your availability. Mark (X) in All that apply.

Evenings

Weekends

Weekdays

b.Total hours per week you are willing to work, up to and including 40.

If you have additional information continue in Section D.