Csc Form PDF Details

Navigating the complexities of employment applications within the United States Civil Service can be a rigorous process, specifically when applying for roles that require the operation of motor vehicles and mobile equipment. The CSC Form 665 plays a crucial role in this process, serving as an Experience Statement Sheet designed to assess the applicant's ability to drive safely. Approved by the Budget Bureau under the number 50-R0279, this form requires detailed information from candidates, including general personal details, a comprehensive history of traffic violations within the past five years (excluding non-guilty verdicts and parking tickets), current driver's license specifics, a record of any accidents occurred, and any safety awards or citations received. The form meticulously gauges an applicant’s history on the road by asking for types of violations or accidents, details of any fines, suspensions, or sentencing, and the presence of safety-related recognitions, thereby ensuring that only those with a proven record of safe driving and responsibility are considered for positions that demand such qualifications. This screening tool not only highlights an individual's driving competence but also underlines the importance of maintaining a clean and safe driving record for those aspiring to operate government vehicles or equipment.

QuestionAnswer
Form NameCsc Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namescsc application form, csc form download, csc form apply, csc form foe

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Form Approved

UNITED STATES CIVIL SERVICE COMMISSION

Budget Bureau No. 50-R0279.

ABILITY TO DRIVE SAFELY

Experience Statement Sheet for Motor Vehicle and Mobil Equipment Operators

Please fill in both sides of this Form. You may have someone help you complete it if you wish.

A. General Information

1. Title of position applied for

2. Date

3.Name (First, middle, last)

4.Birth date (Month, day, year)

5.Address (Number and street, or RD number, city, state, and ZIP Code)

B. Traffic Violations. (Supply the information requested below for each time you were given a ticket or arrested for breaking a driving law during the past 5 years. Do not include any record where you were found no guilty. Also do not include parking tickets.)

 

Type of violation

Mo/Yr.

While

City County, State

License

Fined or

Sentenced?

 

 

 

on job?

 

revoked or

forfeited

 

1

 

 

 

 

suspended?

collateral?

 

 

 

 

Yes □

 

Yes □

Yes □

Yes □

 

 

 

No □

 

No □

No □

No □

 

 

 

 

 

 

 

 

 

Details of action taken (Length of suspension, amount of fine, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

Type of violation

Mo/Yr.

While

City County, State

License

Fined or

Sentenced?

 

 

 

on job?

 

revoked or

forfeited

 

2

 

 

 

 

suspended?

collateral?

 

 

 

 

Yes □

 

Yes □

Yes □

Yes □

 

 

 

No □

 

No □

No □

No □

 

 

 

 

 

 

 

 

 

Details of action taken (Length of suspension, amount of fine, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

Type of violation

Mo/Yr.

While

City County, State

License

Fined or

Sentenced?

 

 

 

on job?

 

revoked or

forfeited

 

3

 

 

 

 

suspended?

collateral?

 

 

 

 

 

 

Yes □

Yes □

Yes □

 

 

 

 

 

No □

No □

No □

 

 

 

 

 

 

 

 

Details of action taken (Length of suspension, amount of fine, etc.)

C. Driver’s License Information

Driver’s permit or license number

State in which it was issued

Date it expires

Restrictions listed in present license

Other States where you obtained license during the past 5 years

CSC Form 665

D. Accident Record. (Complete the information requested for each accident you have had during the past 5 years – whether your fault or not.)

 

 

Type of accident (Head-on collision, hit a tree, etc.)

 

Mo./Yr.

 

 

While on

City, County, State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

job?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes □

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No □

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount of damage to

Amount of

 

Did you or your insurance company make payment to the other party?

 

 

 

 

your car

 

 

 

 

 

 

 

 

 

 

 

□ Yes

No

 

 

damage to the

 

 

 

 

 

 

 

 

 

 

 

1

 

$_________________

 

If ‘Yes,” give amount. $_____________________

 

 

 

 

 

 

 

 

other party’s car

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Was anyone killed?

□ Yes

□ No

 

 

 

 

Were you judged at fault?

Yes

□ No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Describe charges placed against you, if any

 

License

Fined or

 

Sentenced?

Details of action taken (sentenced length of suspension,

 

 

 

 

 

 

 

revoked or

forfeited

 

 

 

amount of fine, etc.)

 

 

 

 

 

 

 

 

 

 

 

suspended

collateral?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

Yes

 

Yes

 

 

 

 

 

 

 

 

 

 

 

 

 

No

No

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of accident (Head-on collision, hit a tree, etc.)

 

Mo./Yr.

 

 

While on

City, County, State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

job?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes □

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No □

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount of damage to

Amount of

 

Did you or your insurance company make payment to the other party?

 

 

 

 

your car

 

 

 

 

 

 

 

 

 

 

 

□ Yes

No

 

 

damage to the

 

 

 

 

 

 

 

 

 

 

 

 

 

$_________________

 

If ‘Yes,” give amount. $_____________________

 

 

 

 

 

 

 

 

other party’s car

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Was anyone killed?

□ Yes

□ No

 

 

 

 

Were you judged at fault?

Yes

□ No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Describe charges placed against you, if any

 

License

Fined or

 

Sentenced?

Details of action taken (sentenced length of suspension,

 

 

 

 

 

 

 

revoked or

forfeited

 

 

 

amount of fine, etc.)

 

 

 

 

 

 

 

 

 

 

 

suspended

collateral?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

Yes

 

Yes

 

 

 

 

 

 

 

 

 

 

 

 

 

No

No

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Safety Awards

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever received a safety award?

 

If yes, give details, including date received

 

 

 

 

 

 

 

Yes

No □

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever received a citation for safe

 

If yes, give details, including date received

 

 

 

 

 

 

 

driving or for being a safe worker?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No □

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you had more than three traffic violations or two accidents within the last 5 years, provide the information requested in Band D above for each on additional sheets.

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.

Signature of applicant

Date

CSC Form 665

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Stage no. 1 for filling out pdf csc form

2. Once your current task is complete, take the next step – fill out all of these fields - Type of violation Details of, Yes No, While on job, MoYr, City County State, License revoked or suspended Yes, Fined or forfeited collateral Yes, Sentenced Yes No, License revoked or suspended Yes, Fined or forfeited collateral Yes, Sentenced Yes No, C Drivers License Information, State in which it was issued, Date it expires, and Other States where you obtained with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Step number 2 for completing pdf csc form

3. This next part is all about D Accident Record Complete the, While on, MoYr, Type of accident Headon collision, City County State, job, Yes No, Amount of damage to your car, Amount of damage to the other, Did you or your insurance company, Was anyone killed Yes No, Describe charges placed against, Were you judged at fault Yes No, License, and revoked or suspended - fill out these fields.

pdf csc form completion process outlined (part 3)

4. The subsequent subsection will require your details in the subsequent areas: Amount of damage to your car, Amount of damage to the other, Was anyone killed Yes No, Were you judged at fault Yes No, Describe charges placed against, License, revoked or suspended, Fined or forfeited collateral, Sentenced, Details of action taken sentenced, Yes No, Yes No, Yes No, E Safety Awards, and If yes give details including date. Be sure that you enter all needed info to go further.

Yes  No, E Safety Awards, and revoked or suspended of pdf csc form

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