Standart Form 256 PDF Details

It’s vital for businesses to stay organized and up-to-date on important documents in order to save time and money when it comes to their daily operations. Having the proper paperwork can be a huge asset, especially when completing a large transaction or performing an audit. One such document that is necessary in various financial transactions is Standard Form 256 (SF-256), which allows businesses and other organizations – both public and private – access to confidential information related to them. In this blog post, we will discuss the basics of SF-256, including who should use it, what you need to know before filling it out, as well as tips for success when submitting your form.

Question	Answer
Form Name	Standart Form 256
Form Length	8 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	2 min
Other names	abiliy, Rican, navy exchange application form, zYes

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NAVY EXCHANGE EMPLOYMENT APPLICATION

PRIVACY ACT NOTICE

Authority: 5 USC 301, E.O. 9397, and Departmental Regulations.

Purpose(s): To collect information needed to determine qualifications, suitability and availability of applicants for employment. Your completed application may be used to examine, rate and/or assess your qualifications, and restrictions based on citizenship, members of family already employed, residence requirements and to contact you concerning availability for an interview.

All or part of your completed NES127 employment application may be disclosed to:

VAppropriate federal, state, or local law enforcement agencies charged with the responsibility of investigating a violation or potential violation of the law. V Your college or university placement office.

Disclosure: Voluntary, however, failure to disclose requested information may result in your not receiving full consideration for a position in which this information is needed.

Name					Position Applied For		Announcement Number			Date

Social Security Number			Street Address				City

County	State		Zip Code		Home Phone		Alternate Phone			Salary Desired

Date Available To Start Work:					Interested in:	Z Full-time Z Part-time	Z Flex	Z 1st Shift	Z 2nd Shift Z 3rd Shift

Military Dep	Are you 18 years or older?			Are you	a U.S. citizen or national, an alien lawfully admitted to permanent residence authorized to work in the
Z Yes Z No	Z Yes	Z No		U.S?

Relative(s) employed with, and/or have business dealings with the Navy Exchange System. (Name(s) , Position(s) and Relationship). Z No Z Yes:	Explain

Have you ever pled guilty, no contest, had a suspended imposition of sentence, or been convicted of any offense (other than minor traffic violations)?	Z Yes
Z No

If yes, state dates, places, and nature of each conviction. Attach additional pages as necessary. (A conviction record will not necessarily result in denial of

	(List most recent employment first)	BUSINESS OR WORK HISTORY			(* Required fields regardless of
resume submitted)
	NAME OF COMPANY			KIND OF BUSINESS	TELEPHONE NUMBER

	STREET ADDRESS		CITY	STATE	ZIP CODE

	NAME AND TITLE OF IMMEDIATE SUPERVISOR			MO/YR EMPLOYED *	STARTING SALARY*

	YOUR TITLE AND DESCRIPTION OF DUTIES			MO/YR LEFT*	SALARY AT LEAVING*

				REASON FOR LEAVING


	NAME OF COMPANY			KIND OF BUSINESS	TELEPHONE NUMBER

	STREET ADDRESS		CITY	STATE	ZIP CODE

	NAME AND TITLE OF IMMEDIATE SUPERVISOR			MO/YR EMPLOYED *	STARTING SALARY*

	YOUR TITLE AND DESCRIPTION OF DUTIES			MO/YR LEFT*	SALARY AT LEAVING*

				REASON FOR LEAVING*

	NAME OF COMPANY			KIND OF BUSINESS	TELEPHONE NUMBER

	STREET ADDRESS		CITY	STATE	ZIP CODE

	NAME AND TITLE OF IMMEDIATE SUPERVISOR			MO/YR EMPLOYED *	STARTING SALARY*

YOUR TITLE AND DESCRIPTION OF DUTIES

MO/YR LEFT*

SALARY AT LEAVING*

REASON FOR LEAVING*

(Work history supplement available upon request)

EDUCATION

TYPE OF SCHOOL	NAME OF SCHOOL, CITY AND STATE	MAJOR FIELD	DEGREE	YEARS	CREDIT
				ATTENDED	HOURS

HIGH SCHOOL
COLLEGE

GRADUATE SCHOOL

TRADE SCHOOL
OR OTHER

List extracurricular activities you participated in:

MILITARY

BRANCH OF SERVICE

DATE DISCHARGED

RANK AT SEPARATION

TYPE OF DISCHARGE

RETIRED?

Z Yes

Z No

Describe briefly major duties and responsibilities.

How did you hear about employment opportunities at the Navy Exchange?

State Employment Office

NEXCOM Website

Friend

Newspaper Ad

Walk-in

Other

_________________________ Z

Web Advertisement

Have you ever worked in the Navy Exchange Program? Z

Yes

Z No ( If yes, give full details: Where? When? From - To: Job Title, Salary, etc.)

Have you ever worked for another NAF (i.e. MWR, AAFES, Marine Corps exchange, etc.)

Z Yes

Z No (If yes, Job Title? Salary? Agency/Location?

Employment Dates?)

Have you ever received benefits under the Voluntary Separation Incentive (VSI) or Special Separation Benefit (SSB)?

Z Yes

Z No

Effective 1 Oct 1994, former military members hired by DOD Activities as civilians within 180 days of their separation under either VSI or SSB programs are now required to forfeit all incentives received.

Have you ever worked for the Federal Government as a Civil Service employee?
Z Yes	Z No

If your answer is Yes, give name and address of Agency/Command.

Dates of employment:		From:	/	/		To:	/	/

Have you ever received Separation Incentive Pay (SIP)?					Z Yes	Z No

A government employee who has received a Voluntary Separation Incentive payment and who accepts employment with the Government of the United States within 5 years after the date of the separation on which the payment is based, shall be required to repay the entire amount of the incentive payment to the agency that paid the incentive payment.

If yes, give date received.

REQUIRED CERTIFICATION

I certify that, to the best of my knowledge and belief, my statements and information on this employment application are true, correct, complete, and made in good faith. I consent to the release of information about my ability and fitness for Navy Exchange System employment by employers, schools, law enforcement agencies and other individuals and organizations, to investigators, and other authorized employees of the Navy Exchange System. I agree to supply additional information as required, and to submit to any physical examinations that may be required. I understand that a false statement made by me or false information submitted by me, may be grounds for not hiring me or for terminating me after I have started work.

_____________________________________	___________________
Applicant's Signature	Date

HR OFFICE USE ONLY UPON SELECTION

Job No.

Job Title

Position Number

Grade/Series

Location


Emergency POC: Name		Relationship	Address		Phone Number

Martial Status:	Z Single	Z Married Z Head of Household Z Separated	Z Divorced	Z Widowed	Z Common Law
CRC Recommended Z Yes Z	No

NES127 (Rev. 12/02)	EQUAL OPPORTUNITY EMPLOYER

BACKGROUND VERIFICATION DISCLOSURE

As part of the employment process, the Navy Exchange may obtain a Criminal Record Check and/or an investigative Consumer Report. The Fair Credit Reporting Act, as amended by the Consumer Report Reform Act of 1996, requires that we advise you, that for purposes of employment only, a Consumer Report may be made. This report may include information about your character, general reputation, personal characteristics, or mode of living. Upon written request, additional information as to the nature and scope of the report, if one is made, will be provided in the event that the report contains information regarding your character, general reputation, personal characteristics, or mode of living.

AUTHORIZATION AND RELEASE

During the application process, and at the time during any subsequent employment, I hereby authorize ChoicePoint Services, Inc., on behalf of the Navy Exchange, to procure a Consumer Report, which I understand may include information regarding my character, general information, personal characteristics, or mode of living. This report may be complied with information from court record repositories, department of motor vehicles, past or present employers and educational institutions, governmental occupational licensing or registration entries, business or personal references, and any other source required to verify information that I have voluntarily supplied. I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification, to the extent such investigation includes information bearing on my character, general reputation, personal characteristics, or mode of living.

Applicant/Employee Name and Signature

Date

Social Security Number

Date of Birth

REV 1/04

SELF-IDENTIFICATION OF HANDICAP

(See instructions and Privacy Act information on reverse)

Last Name, First Name, Middle Initial	Birth Date (Mo./Yr.) Social Security Number	ENTER CODE HERE
		ENTER CODE HERE

DEFINITION OF A HANDICAP: A person is handicapped if he or		are to be reported are listed below (codes in bold numbers 13
she has a physical or mental impairment which substantially limits		through 94). In the case of multiple impairments, choose the code
one or more major life activities; has a record of such impairment;		which describes the impairment that would result in the most sub-
or is regarded as having such impairment. Those handicaps that		stantial limitation.

TO THE EMPLOYEE: Self-identification of handicap status is		PARTIAL PARALYSIS
essential for effective data collection and analysis. The informa-		(Because of a brain, nerve, or muscle problem, including palsy and cerebral
tion you provide will be used for statistical purposes only and will		palsy, there is some loss of abiliy to move or use a part of the body, including
		legs, arms, and/or trunk.)
not in any way affect you individually. While self-identification is
		61	One hand	67 One side of body, including one arm
voluntary, your cooperation in providing accurate information is
		62	One arm, any part	and one leg
critical.

		63	One leg, any part

01	I do not wish to identify my handicap status. (Please read the employee
		64	Both hands	68 Three or more major parts of the
	note above and the reverse side of this form before using this code.) (Note:	65	Both legs, any part	body (arms and legs)
	Your personnel officer may use this code if, in his or her judgment, you

		66
	used an incorrect code.)		Both arms, any part

05 I do not have a handicap.		COMPLETE PARALYSIS
		(Because of a brain, nerve, or muscle problem, including palsy and cerebral

		palsy, there is a complete loss of abiliy to move or use a part of the body,
06 I have a handicap but it is not listed below.
		including legs, arms, and/or trunk.)
		70	One hand	76 Lower half of body, including legs
SPEECH IMPAIRMENTS
		71	Both hands

13	Severe speech malfunction or inability to speak; hearing is normal (Ex-	72	One arm	77 One side of body, including one arm
	amples: defects of articulation [unclear language sounds]; stuttering;
		73	Both arms	and one leg
	aphasia [impaired language function]; laryngectomy [removal of the "voice

	box"])	74	One leg	78 Three or more major parts of the
		75	Both legs
				body (arms and legs)
HEARING IMPAIRMENTS



15	Hard of hearing (Total deafness in one ear or inability to hear ordinary	OTHER IMPAIRMENTS
	conversation, correctable with a hearing aid)	80	Heart disease with no restriction or limitation of activity (History of heart
16	Total deafness in both ears, with understandable speech
			problems with complete recovery)

17Total deafness in both ears, and unable to speak clearly

	81	Heart disease with restriction or limitation of activity
	82	Convulsive disorder (e.g., epilepsy)
VISION IMPAIRMENTS	82	Convulsive disorder (e.g., epilepsy)
22 Ability to read ordinary size print with glasses, but with loss of peripheral	83	Blood diseases (e.g., sickle cell anemia, leukemia, hemophilia)
(side) vision (Restriction of the visual field to the extent that mobility is	83

affected--"Tunnel vision")	84	Diabetes
	84	Diabetes

23Inability to read ordinary size print, not correctable by glasses (Can read

	oversized print or use assisting devices such as glass or projector modifier)	86	Pulmonary or respiratory disorders (e.g., tuberculosis, emphysema,
24	Blind in one eye		asthma)
25	Blind in both eyes (No usable vision, but may have some light perception)	87	Kidney dysfunctioning (e.g., if dialysis [Use of an artificial kidney machine]
		87
			is required)
MISSING EXTREMITIES			is required)
MISSING EXTREMITIES
27	One hand	88	Cancer--a history of cancer with complete recovery
27	One hand
28	One arm	89	Cancer--undergoing surgical and/or medical treatment
		89	Cancer--undergoing surgical and/or medical treatment

29One foot

32	One leg	90 Mental retardation (A chronic and lifelong condition involving a limited ability
33	Both hands or arms	to learn, to be educated, and to be trained for useful productive employ-
		ment as certified by a State Vocational Rehabilitation agency under sec-
34	Both feet or legs
		tion 213.3102(t) of Schedule A)

35One hand or arm and one foot or leg

36	One hand or arm and both feet or legs				91	Mental or emotional illness (A history of treatment for mental or emotional
37	Both hands or arms and one foot or leg					problems)
37	Both hands or arms and one foot or leg
38	Both hands or arms and both feet or legs				92	Severe distortion of limbs and/or spine (e.g., dwarfism, kyphosis [severe
						distortion of back])
NONPARALYTIC ORTHOPEDIC IMPAIRMENTS						distortion of back])
NONPARALYTIC ORTHOPEDIC IMPAIRMENTS
(Because of chronic pain, stiffness, or weakness in bones or joints, there is					93	Disfigurement of face, hands, or feet (e.g., distortion of features on skin,
some loss of ability to move or use a part or parts of the body.)						such as those caused by burns, gunshot injuries, and birth defects [gross
44	One or both hands		47	One or both legs		facial birthmarks, club feet, etc.])
45	One or both feet		48	Hip or pelvis	94	Learning disability (A disorder in one or more of the processes involved
					94
46	One or both arms		49	Back		in understanding, perceiving, or using language or concepts [spoken or
57	Any combination of two or more parts of the body					written]; e.g., dyslexia)
57	Any combination of two or more parts of the body

256-104		7540-01-028-2848		Previous edition unusable		Standard Form 256 (Rev. 8/87)
256-104		7540-01-028-2848		Previous edition unusable		U.S. Office of Personnel Management
						U.S. Office of Personnel Management

FPM Supplement 296-1

will as-

with the exception of employ-

The Rehabilitation Act of 1973 (P.L. 93-112) requires each agency in the Executive branch of the Federal Govern- ment to establish definite programs that will facilitate the hiring, placement, and advancement of handicapped indi- viduals. The best means of determining agency progress in this respect is through the production of reports at cer- tain intervals showing such things as the number of handi- capped employees hired, promoted, trained, or reassigned over a given time period; the percentage of handicapped employees in the work force and in various grades and occupations; etc. Such reports bring to the attention of agency top management, the Office of Personnel Manage- ment (OPM), and the Congress deficiencies within specific agencies or the Federal Government as a whole in the hir- ing, placement, and advancement of handicapped individ- uals and, therefore, are the essential first step in improving these conditions and consequently meeting the require- ments of the Rehabilitation Act.

The handicap data collected on employees will be used only in the production of reports such as those previously mentioned and not for any purpose that will affect them individually. The only exception to this rule is that the rec- ords may be used for selective placement purposes and selecting special populations for mailing of voluntary per- sonnel research surveys. In addition, every precaution will be taken to ensure that the information provided by each employee is kept in the strictest confidence and is known only to the one or two individuals in the agency Personnel Office who obtain and record the information for entry into the agency's and OPM's personnel systems. You should also be aware that participation in the handicap reporting system is entirely voluntary,

ees appointed under Schedule A, section 213.3102(t) (Men- tal Retardation); Schedule A, section 213.3102(u) (Severely Physically Handicapped); and Schedule B, section 213.3202(k) (Mentally Restored). These employees will

be requested to identify their handicap status and if they decline to do so, their correct handicap code will be ob- tained from medical documentation used to support their appointment. No other employees will be required to iden- tify their handicap status if they feel for any reason it is not in their best interest to have this information officially re- corded outside of medical records. We request only that anyone not wishing to have this information entered in the agency's and OPM's personnel systems indicate this to their Personnel Office, rather than intentionally miscoding them- selves, since false responses will seriously damage the sta- tistical value of the reporting system.

[In those instances where the employee is or was hired under Schedule A, section 213.3102(t) (Mental Retarda- tion), the Personnel Director or his/her disignee (a Voca- tional Rehabilitation Counselor may also be helpful)

sist the individual in completing this form and ensure that the employee fully understands the meaning of the form and the options available to him/her, as noted above.]

Employees will be given every opportunity to ensure that the handicap code carried in their agency's and OPM's personnel systems is accurate and is kept current. They may exercise this opportunity by asking their Personnel Officer to see a printout of the code and definition from their record, by notifying Personnel any time their handi- cap status changes, and by initiating action in either of these cases to have the necessary changes made to their records. The code carried on employees in their agency's system will be identical to that carried in OPM's system, and any change to the agency records will result in the same change being made to OPM's records.

PRIVACY ACT STATEMENT

Collection of the requested information is authorized by the Rehabilitation Act of 1973 (P.L. 93-112). The informa- tion you furnish will be used for the purpose of producing statistical reports to show agency progress in hiring, place- ment, and advancement of handicapped individuals and to locate individuals for voluntary participation in surveys. The reports will be used to inform agency top management, the Office of Personnel Management (OPM), the Congress, and the public of the status of programs for employment of the handicapped. All such reports will be in the form of aggregate totals and will not identify you in any way as an individual.

Solicitation of your Social Security Number (SSN) is auth- orized by Executive Order 9397, which requires agencies to use the SSN as the means for identifying individuals in personnel information systems. Your SSN will only be used to ensure that your correct handicap code is recorded along with the other employee information that your agency and OPM maintain on you. Furnishing your SSN or any other of the requested data for this collection effort is voluntary and failure to do so will have no effect on you. It should be noted, however, that where individuals decline to furnish their SSN, the SSN will be obtained from other records in order to ensure accurate and complete data.

Employees appointed under Schedule A, section 213.3102(t) (Mental Retardation), Schedule A, section 213.3102(u) (Severely Physically Handicapped), or Sched- ule B, section 213.3202(k) (Mentally Restored) are re- quested to furnish an accurate handicap code, but failure

to do so will have no effect on them. Where employees hired under one of these appointments fail to disclose their handi- cap, however, the appropriate code will be determined from the employee's existing records or medical documentation submitted to justify the appointment.

Standard Form 256 BACK *U.S. GPO:1991-0-290-49/20214

BACKGROUND SURVEY QUESTIONNAIRE

The Navy Exchange System is an Equal Opportunity Employer. In order to achieve equal opportunity goals, it is necessary to collect data relative to the ethnic, racial, and sexual and handicap background of our work force. Although providing this information by completing these forms is optional on your part, your cooperation is asked so that we may achieve our goal of equality. This information is kept confidential and is not provided to selecting officials.

This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), December 31, 1974, for individuals completing federal records and forms that solicit personal information. (Data required for U.S. citizens only.)

Name (Last, First, MI)

Position for which you are applying		Date (Month, Day, Year)

Location of Position		Announcement No.

Social Security Number	Year of Birth	Gender (Male/Female)

Please categorize yourself in terms of the race and ethnic categories below. First read definitions of subcategories and fill in the appropriate letter.

DEFINITIONS

The racial and ethnic categories for federal statistics and administrative reporting are defined as follows.

Race		Code
American Indian or Alaskan	A person having origins in any of the original peoples of	A
Native	North America, and who maintains cultural identification
	through community recognition of tribal affiliation.
Asian or Pacific Islander	A person having origins in any of the original peoples of the	B
	Far East, Southeast Asia, the Indian subcontinent or the
	Pacific Islands. This are includes, for example, China, India,
	Japan, Korea, the Philippine Islands, and Samoa.
Black, not of Hispanic origin	A person having origins in any of the black racial groups of	C
	Africa except persons of Mexican, Puerto Rican, Cuban,
	Central or South American, or other Spanish cultures or
	origins. (see Hispanic)
Hispanic	A person of Mexican, Puerto Rican, Cuban, Central or South	D
	American, or other Spanish cultures or origins. Does not
	include persons of Portugese culture or origin.
White, not of Hispanic origin	A person having origins in any of the original peoples of	E
	Europe, North Africa, or Middle East, except persons of
	Mexican, Puerto Rican, Cuban, Central or South American, or
	other Spanish cultures or origins. (see Hispanic) Also
	includes persons not included in other categories.

BACKGROUND SURVEY QUESTIONNAIRE

FOR USE IN HAWAII and GUAM ONLY

Name (Last, First, MI)

Position for which you are applying		Date (Month, Day, Year)

Location of Position		Announcement No.

Social Security Number	Year of Birth	Gender (Male/Female)

Specific Instructions: The categories below are designed to identify your basic racial and national origin category. If you are of mixed racial and/or national origin, identify yourself by the category with which you most closely identify yourself. Read the definitions below and fill in the appropriate letter.

DEFINITIONS

The racial and ethnic categories for federal statistics and administrative reporting are defined as follows.

Race		Code
American Indian or	A person having origins in any of the original peoples of North America, and who	A
Alaskan Native	maintains cultural identification through community recognition of tribal affiliation.
Black, not of Hispanic	A person having origins in any of the black racial groups of Africa except persons	C
origin	of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish
	cultures or origins. (see Hispanic)
Hispanic	A person of Mexican, Puerto Rican, Cuban, Central or South American, or other	D
	Spanish cultures or origins. Does not include persons of Portugese culture or origin.
White, not of Hispanic	A person having origins in any of the original peoples of Europe, North Africa, or	E
origin	Middle East, except persons of Mexican, Puerto Rican, Cuban, Central or South
	American, or other Spanish cultures or origins. (see Hispanic) Also includes
	persons not included in other categories.
Asian Indian	A person having origins in any or the original peoples of the Indian subcontinent	F
	(i.e., India, Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim, and Bhutan).
Chinese	A Person having origins in any of the original peoples of China.	G
Filipino	A person having origins in any of the original peoples of the Philippines.	H
Guamanian	A Person having origins in any of the original peoples of Guam. (e.g., Chamorro).	J
Hawaiian	A person having origins in any of the original peoples of Hawaii, includes persons	K
	who are Part Hawaiian and identify most closely with the Hawaiian category.
Japanese	A person having origins in any of the original peoples of Japan.	L
Korean	A person having origins in any of the original peoples of Korea.	M
Samoan	A person having origins in any of the original peoples of Samoa.	N
Vietnamese	A person having origins in any of the original peoples of Vietnam.	P
All Other Asian or	A person having origins in any of the original peoples of Asia or the Pacific Islands	Q
Pacific Islanders	not included in codes F through P above.

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