Notice of Request for Approval of Application Form Submitted to the Office of Management and Budget

OFFICE OF PERSONNEL MANAGEMENT

Notice of Request for Approval of Application Form Submitted to

the Office of Management and Budget

AGENCY: President's Commission on White House Fellowships.

ACTION: Notice.

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SUMMARY: In accordance with the Paperwork Reduction Act of 1980 (44

U.S. Code, chapter 35), this notice announces a proposed revision of

the White House Fellowship Application which has been submitted to the

Office of Management and Budget for approval. This form is completed by

persons wishing to apply for a Fellowship. The information is used by

the Commission to evaluate an applicant's qualifications.

Approximately 1,000 applications are completed annually, requiring

an estimated five hours each, for a total annual burden of 5,000 hours.

Response is required to be considered for a Fellowship.

A copy of the proposal is appended to this Notice.

DATES: Comments on this proposal should be received within 10 calendar

days from the date of this publication. OMB has been requested to take

action within 10 calendar days.

ADDRESS: Send or deliver comments to Joseph Lackey, Desk Officer,

Office of Information and Regulatory Affairs, Office of Management and

Budget, New Executive Office Building NW., Room 10235, Washington, DC

20503, U.S. Office of Personnel Management.

Lorraine A. Green,

Deputy Director, Office of Personnel Management.

White House Fellowship Application

Instructions

Type all responses. Answer all questions fully and accurately, and

sign and date the application in the space provided in Question 4.

Questions 1-4 should be answered on the first two pages of the

application. (These pages may be recreated on a word processor,

however, the format must remain exactly the same.)

Be sure to carefully follow the directions for Question 5: it is

your receipt.

The remaining questions should be answered on separate sheets of

plain white 8\1/2\'' x 11'' paper. Each sheet should include your name,

social security number, and the question number in the upper right

corner.

You may include additional items with your application, such as

publications featuring or authored by you, books you have written, or

music you have recorded. Use your best judgment. Generally, unpublished

academic papers and copies of award certificates are not helpful.

Applications must be postmarked by December 1. It is the

responsibility of the applicant to ensure a package mailed on December

1 is postmarked with that date. Applications mailed from overseas

should be sent by air mail as early as possible. Mail applications to:

The President's Commission on White House Fellowships, 712 Jackson

Place, NW., Washington, DC 20503. While applications may be downloaded

electronically from the Internet, they may not be filed by e-mail. Only

hard-copy paper applications with original signatures will be accepted.

Applicants will be notified by mail that their application has been

received.

Only U.S. citizens are eligible to apply. Civilian employees of the

federal government are not eligible. The Commission cannot consider

applications from ineligible applicants, nor grant exemptions from

these requirements.

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The federal government is an equal opportunity employer. Hiring is

based on qualifications and performance regardless of race, color,

creed, religion, sex, age, national origin, sexual orientation or

disability.

Application Checklist

First 2 pages of the application (Questions 1-4)

Cards requested in Question 5

Lists and essays (Questions 6-15)

Sealed recommendations (Question 16)

Part I

1. Personal Data

Name (last, first, middle)

Mr. Mrs. Ms. Other

Birthdate (mo/day/yr)

Other names used

Are you a US citizen: Yes No

Social Security Number

Occupation: (Profession, student, self-employed, retired, etc.)

Current employer's name and address:

Your title, rank, or status:

Home address:

Mailing address where you wish to receive Commission mailings, if

different from above:

Home phone:

Work phone:

Fax number:

E-mail address:

Have you ever worked for or are you now working for the federal

government, or are you being paid by federal funds? (Include active

duty military service.) If so, please explain below and give inclusive

dates.

Yes No

Explanation:

2. Personal Declarations

Please answer the following questions and explain on a separate

sheet of paper details and resolution of any question answered ``yes.''

Have you ever been discharged from the Armed Forces under other

than honorable conditions?

Yes No

Have you ever been convicted of a criminal offense?

Yes No

Have you ever been charged with a felony?

Yes No

Have you ever been charged with a violation of any firearms or

explosives laws?

Yes No

Have you ever failed to meet a court-ordered child support payment?

Yes No

Are you delinquent on any federal debt?

Yes No

Have you ever been suspended, disciplined, or barred from any

occupation or practice by any regulatory agency, professional

association or organization because of your conduct?

Yes No

3. References

In the space below, list the names and contact information for the

individuals whose personal evaluations accompany this application (see

Question 14). You may submit a minimum of 3 and a maximum of 5

recommendations for consideration.

Name-------------------------------------------------------------------

Address----------------------------------------------------------------

Phone------------------------------------------------------------------

4. Certification

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. I know and understand that any or all items

contained herein may be reviewed by representatives of the Commission,

including former White House Fellows, and are subject to investigation

or verification and I consent to the full release of all information

concerning my capacity and fitness by employers, educational

institutions (who are authorized to release my academic records), law

enforcement agencies, and other individuals and agencies to duly

accredited investigators of the federal government or the Commission

for that purpose.

Signature (in ink)

Date-------------------------------------------------------------------

5. Required Cards

The following must be included with your application or it will not

be considered:

A typed 3'' x 5'' index card that lists on one side your name,

address, home and work phone numbers, date of birth, and date of our

application; and

A self-addressed, stamped postcard. This card will be mailed to you

as a receipt upon its arrival in the Commission office.

Part II

Instructions

The following questions should be answered on separate sheets of

paper. Type your name, social security number and question number in

the upper right corner of each page. Do not return or reproduce the

questions with your application; submit only your answers.

6. Career Summary

It is helpful for the Commissioners evaluating your application to

see ``at a glance'' the development of education and career patterns.

Therefore, on a separate sheet of paper under the heading, ``Career

Summary,'' please provide a chronological listing of all positions you

have held, beginning with the most recent. Include dates, employers

and/or schools attended. Account for all periods of unemployment.

Please limit your response to a maximum of one page; details can be

furnished in response to later questions.

Example:

6/92-present--Sr. Vice President, Acme Pictures

9/90-9/92--Director of Sales, Acme Pictures

6/90-9/90--Unemployed-job search

8/89-6/90--MBA student, Enormous State University

8/86-6/89--College student, Small State College

7. Educational Background

On a separate sheet of paper, type the heading ``Educational

Background'' and include the following. Generally, answers to this

question should not exceed one page.

A. Under the heading, ``Schools Attended,'' list all schools

attended, including high school. List the degree or diploma earned, the

name of each school, its location, dates attended and class rank.

Example:

MBA, Enormous State University, Anytown, USA, 8/89-8/90, top

quarter.

BS, engineering, Small State College, Anothertown, USA, 8/86-8/89,

school does not rank students.

B. If appropriate, under the heading, ``Tests and Exams,'' list all

tests and examinations required of you in order to quality for the

practice of any occupation or profession. For each test or examination,

list each time you took the test, the administrating agency, the state

or jurisdiction and year of such exam. For each test, also indicate

whether or not you passed or failed.

C. Under the heading, ``Activities,'' list all of the major

extracurricular activities in which you participated. Briefly explain

each one and list the level of your participation, including any

offices held, the length of your membership and the level of your

participation. Also list any major awards or recognitions received.

[[Page 43824]]

8. Work Experience

On a separate sheet of paper, type the heading ``Work Experience''

and list information about your employment history. Work back from your

current position and account for all periods of employment and

unemployment. Do not substitute a resume. You may use as many sheets as

required. Use the following as a guide:

Dates of employment

Exact job title

Employer

Employer's address and phone number

Nature of the business

Salary history

Number of workers you supervised

9. For each entry you may, at your option, provide a brief

narrative description of the work you performed, not to exceed 200

words for your current position and 100 words for all previous

positions. Describe any outstanding contributions made by you and list

any citations, awards, or unusual promotions.

Example:

6/92-present

Sr. Vice President

Acme Pictures, Inc.

1234 C Street, Anytown, USA 54321. (202) 555-1212

Videotape distributor

Paid $70,000/yr on 6/92; currently earn $80,000/year

Supervise 19 employees

10. Professional and Occupational Activities

On a separate sheet of paper, type of the heading, ``Professional

and Occupational Activities'' and list the major business and

professional activities in which you have participated during the past

ten years. Use the following guide:

Name of organization

City and state

Purpose or objective of the organization

Size of organization

Your level of participation

Dates of your participation

Awards or recognition you received for participation

Example:

The Generic Business Get-Together Group

Washington, DC

Professional advancement of business; lobbies Congress

2,000 nationwide

Co-founder; current vice president

8/93-present

No awards

11. Most Significant Achievement-Professional

On a separate sheet of paper, type the heading, ``Professional

Achievement'' and then describe in 200 words or fewer what you consider

to be your most significant contribution to your professional field. If

you exceed 200 words your application will be disqualified.

12. Most Significant Achievement-Community Service

On a separate sheet of paper, type the heading, ``Community Service

Achievement'' and then describe in 200 words or fewer what you consider

to be your most significant voluntary contribution to your community.

If you exceed 200 words your application will be disqualified.

13. Memorandum for the President

On a separate sheet of paper, type the heading, ``Memorandum for

the President'' and write a memorandum of not more than 500 words for

the President, making a specific policy proposal. Explain why you think

it is important, what issues it raises, and why you think the President

should support it. If you exceed 500 words your application will be

disqualified.

14. Lifetime Goals

On a separate sheet of paper, type the heading ``Lifetime Goals''

and describe in 300 words or fewer your life's ambition, what you hope

to accomplish or achieve in your lifetime, and what position you hope

to attain. If you exceed 300 words your application will be

disqualified.

15. Why I Want to be a White House Fellow

On a separate sheet of paper, type the heading, ``Why I Want to be

a White House Fellow'' and describe in 300 words or fewer why you want

to be a White House Fellow, what you consider to be your major

strengths and qualifications for the program, and what benefits you

feel are likely to result from your participation. If you exceed 300

words your application will be disqualified.

16. References

Please reproduce the enclosed personal evaluation letter and give

it to a minimum of 3 and a maximum of 5 people who know you well.

Recommenders should have a direct knowledge of your qualifications and

character. At least one person listed should have professional

competence in your field, at least one should have knowledge of your

major community or civic activities, at least one should have knowledge

of your business or professional accomplishments, and at least one

should be your present supervisor, if applicable. Each reference should

seal the letter of recommendation in an envelope, sign his or her name

across the seal, and return the form to you. These references must be

included in your application. Your application cannot be considered

without these references.

White House Fellowship Application Candidate Evaluation

To: Individuals Completing an Evaluation

Subject: (Applicant's name)

From: The President's Commission on White House Fellowships

Thank you for taking the time to write a recommendation for the

White House Fellowship applicant named above. Your candid and specific

responses to the questions below will help the President's Commission

select the next class of Fellows, 11 to 19 individuals from across the

nation who will come to Washington to work for one year as paid, full-

time special assistants to Cabinet officers and senior White House

officials.

Please answer the following questions (on your office letterhead,

if appropriate) and include your daytime telephone number. Please sign

your evaluation, place it in a sealed envelope, write your signature

over the seal, and return it to the applicant. The applicant must

submit your evaluation as part of his or her application.

1. How long and in what connection have you known the applicant?

2. What are the applicant's major strengths? Please relate an occasion

in which these strengths were demonstrated.

3. What are the applicant's major weaknesses?

4. What impact has the applicant had on his/her professional field?

5. What impact has he/she had in the community, outside the applicant's

professional realm?

6. What has the candidate done that you consider creative?

7. How would you rate this candidate's writing ability?

8. How would you rate this candidate's intellectual ability?

9. How would you rate this candidate's public speaking ability?

10. How would you rate this candidate's personal integrity?

11. How would your rate this candidate's consensus-building,

negotiating and leadership skills?

[[Page 43825]]

12. If you were a Cabinet Secretary, would you hire this person to be a

key member of your staff?

13. What would you expect this candidate to be doing in 15 to 20 years?

Privacy Act and Paperwork Reduction Act Statements

Pursuant to the Freedom of Information Act (5 U.S.C. 552, as

amended) and the Privacy Act (5 U.S.C. 552a), the President's

Commission on White House Fellowships operates its competitive

application process and collects personal information for its use in

evaluating applicants under authority of Executive Order 11183, as

amended. Submission of the information is voluntary; however,

failure to furnish all the requested information may result in delay

or elimination of consideration for a Fellowship. All files,

records, and other material submitted by or in behalf of any

applicant, or collected or obtained with regard to an applicant, are

used by those persons associated with the Commission for the purpose

of screening and evaluating applications. The information may also

be disclosed to a congressional office in response to an inquiry

from that office made at the request of that individual. Executive

Order 9397 provides for the collection of Social Security Numbers to

identify individual records. Furnishing your Social Security Number

is voluntary; however, failure to do so may delay the processing of

your application.

This request is in accordance with the clearance requirements of

the Paperwork Reduction Act (44 U.S.C. 3507). The information is

being collected in order to evaluate your qualifications for a

Fellowship. Your response is required to make this determination.

Public reporting burden for this collection of information is

estimated to average five (5) hours per response, including time for

reviewing instructions, gathering the requested personal

evaluations, and completing the application. Please send comments

regarding this burden estimate or any other aspect of this

collection of information, including suggestions for reducing the

burden, to the President's Commission on White House Fellowships,

Washington, DC 20415.

Records Retention

The application forms of persons selected as White House Fellows

may be circulated to appropriate Executive Branch officials incident

to placing Fellows in assignments for the Fellowship year and

subsequently may be retained, along with other applicant file

materials, by the Commission in its permanent files on persons who

are selected as White House Fellows. These permanent records are

accessible to the individuals concerned.

Sixty days after a letter has been mailed to an applicant

advising that he or she has been eliminated from the competition,

all materials in the applicant's file will be destroyed and this

procedure will be repeated after each stage of the selection

process.

The Commission cannot assume responsibility for the return of

applications or supporting documents. Applicants are therefore

advised to retain copies of their application forms and not to

submit irreplaceable documents or other materials with applications.

[FR Doc. 95-20947 Filed 8-22-95; 8:45 am]

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