AC-3300-70 Air Traffic Control Specialist (Center/Terminal) AT-2152

OMB Control Number 2120-0597

Air Traffic Control Specialist (Center/Terminal), AT-2152-AG
GEOGRAPHIC PREFERENCES
(Veterans Readjustment Appointment)
Name: _______________________________________
Last

First

Social Security Number: _______-_______-___________

MI

Please select at least 1 location, but no more than 5, where you would like to be employed. All locations are of equal preference. You
will only be referred for employment consideration at locations you select, and you will only be referred for one location at a time. In
addition, you will only be referred if you are among the qualified and available applicants within reach to be referred when vacancies
occur.

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ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA

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MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA

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OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

q CARIBBEAN (Puerto Rico & Virgin Islands)
q PACIFIC ISLANDS (Guam, American
Samoa, & Marshall Islands)

Signature: __________________________________

Date: _____________________________________________

Privacy Act and Paperwork Reduction Act Statement
Public Law 104-50 allows the Federal Aviation Administration (FAA) to determine how qualified applicants will be referred for employment consideration when
vacancies occur. The information requested on this form will be used to determine where you are referred for employment consideration if you are among the
qualified applicants within reach to be referred. Providing this information is voluntary; however, you will never be referred for employment consideration if you do
not select at least one location, and you will only be referred for vacancies at locations that you select on this form. The information we collect on this form will be
used for employment purposes, and it may also be used for statistical studies or computer mat ching with other government files. The nature of information received is
confidential and authorized officials will handle it appropriately. This information becomes part of a Privacy Act System of Records as identified in 5 CFR §552a,
and any disclosure of this record or information in this record is in accordance with routine uses found in System Notice OPM/GOVT-5, Recruiting, Examining and
Placement Records.
Your social security number (SSN) is needed to keep our records accurate because other people may have the same name and birth date. Public Law 104-134 (April
26, 1996) asks Federal agencies to use this number to help identify individuals in agency records. Providing your SSN is voluntary; however, if you do not give us
your SSN, we cannot process your application, so you cannot be considered for employment.
We estimate that this form takes an average of 5 minutes to complete, including time for reviewing instruction, searching existing data sources, gathering data, and
reviewing responses. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid
OMB number. The OMB number associated with this collection is 2120-0597.

AC Form 3300-70 (09/04)