Faa Form 3330 43 1 – Fill Out and Use

•You must furnish all requested information. The information you provide will be used to determine you qualifications and rating. Do not submit a resume in lieu of completing this form.

•If you fail to answer all questions fully and accurately, you may lose employment opportunities.

•So that it is understood that you did not omit an item, please write the letters "N/A" (not applicable) beside those items that do not apply to you.

•Read the vacancy announcement (if applicable) for the position advertised to be certain that your experience and education meet the requirements.

•Be sure to include all forms that may be required.

-FAA Form 3330-42, Request for Transfer Consideration and Acknowledgement.

-FAA Form 3330-43-1, Rating of Air Traffic Experience for AT Movement

--Any other information required by the position vacancy announcement.

•Submit the above along with a stamped envelope, addressed as directed in the vacancy announcement, to your rating official on or before the vacancy closing date (if applicable).

•This form is to be used for applications for CPC/TMC/TMS positions only.

Candidate Information.

Self-explanatory.

Selective Placement Factors.

Check the appropriate box. Candidates who have not satisfied appropriate selective placement factors are not qualified for the vacancy.

TALLY

For use of Rating Official only. Use Tally to record values for each factor. Add up the total score and enter it in the box at top right of form. Normally, the employee's first-level supervisor is the rating official.

FACTOR 1 - Facility Complexity Level. (Max. 42 pts.) Points are assigned for the highest level ATC facility to which the applicant was permanently assigned and facility/area certified as a CPC/TMC/TMS. Assign 3 points times the highest level. For employees who are not currently in an ATC facility, use the conversion table below to get the ATC level equivalent. Use the table to convert FPL level FG/GS to ATC levels. Award the point value that would provide the maximum benefit to the employee.

Example: An applicant with 5 years as FG-13, and 1 year at ATC-10 facility. The FG-13 = 9 x 3 = 27 while ATC- 10 = 10 x 3 = 30 points.

For developmental applicants who have never achieved CPC status, credit the following points for each developmental stage successfully completed at the highest ATC level facility to which they were permanently assigned. [This section does not apply to CPCs in training status (CPCIT)]

Example: A developmental employee successfully completed 2 phases of training at an ATC-11 facility and then moved to, and completed, 1 phase of training, at an ATC-9 facility. This employee would receive points for phases completed only at the highest ATC level facility: ATC-11 = 7 X 2 phases completed = 14 points. Total for Factor 2 would be 14.

FACTOR 2 - Aviation Experience. (Max 5 pts.)

Points are credited for each certificate or rating obtained.

Aviation Experience

FACTOR 3 - Experience and Recency. (Max. 50

pts.) Assign 2 points for each full year in an ATS-2152 position. Deduct 1 point for each full year since certification was lost. For CPC/TMC/TMS positions, deduct 1 additional point for each full year since the candidate served in an ATS terminal or center CPC/TMC/TMS position.

Example: An applicant with 10 years ATS 2152 time; (5 years Terminal or Center CPC/TMC/TMS, 3 years facility staff, 2 years regional office experience) is bidding on a Terminal/Center CPC/TMC/TMS position. Credit employee: ATS-2152 time = 10X2 = 20 points. Certification not required as facility or regional office staff = [-(3+2)} = -5 points. 5 Years since last a Terminal/Center CPC/TMC/TMS=5 x (-1) = -5 points. Total=20 -5 -5 = 10 points total.

Example: Employee has 3 years ATS 2152 developmental experience in Terminal or Center option bidding on an ATS Terminal/Center CPC position. Employee is credited with ATS time, 3 X 2 = 6 points for this factor.

(DoD 2152 time is not credited for Factor 3.)

FACTOR 4 - Education and Self Development. (Max. 27 pts.) Complete all appropriate items as listed on the form. Correspondence

ATC

LEVEL

8

7

6

5

POINTS

5

5

4

4

courses are to be listed on a separate sheet by title and dates completed.

FACTOR 5- Awards. (Max. 10 pts.) This factor credits awards and recognition. Complete all appropriate items as listed on the form.

Private Pilot

Commercial Pilot

Instrument Rating

Certified Flight Instructor

Dispatcher Certificate

4c. Long-Term Training

Date Completed

(5 points)

FACTOR 4 GRAND TOTAL

4a ___________ + 4b ___________ + 4c___________ =

(MAXIMUM 27)

Type

Date

Value

Type

Date

Value

Type

Date

Value

CERTIFICATION OF CANDIDATE: 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.

CERTIFICATION OF RATING OFFICIAL: I certify that this rating is true, complete, and correct to the best of my knowledge and belief.

Date

Signature of Candidate

Date

Signature of Rating Official