Form BC-170A Census Employment Inquiry

Census Field
Representative Jobs
U.S. Department of Commerce •

Economics and Statistics Administration

• U.S. CENSUS BUREAU

The Census Bureau is an
Equal Opportunity Employer
WORK AS A CENSUS FIELD REPRESENTATIVE
The U.S. Census Bureau has employment opportunities for
survey interviewers (called field representatives) and related
positions to collect survey data for the federal government.
Census field representatives may work varied schedules
depending on assignments and survey requirements.
DUTIES
You are assigned a group of specific households or persons to
visit or telephone during a certain period of the month. You will
use official Census Bureau questionnaires or a laptop
computer, and record answers from the interview according to
instructions you receive in training. A Census Bureau
supervisor will usually accompany you on your first
assignment. Most of your subsequent contacts with your
supervisor will be by phone.
The information you collect is confidential and must
not be disclosed to anyone who has not sworn to
protect Census Bureau information.
TRAINING
Initial classroom training for survey work will generally last 3–5
days and may require you to travel to another city. Later
training includes self-study and refresher training sessions. You
will be paid for time spent in training and for travel costs
required to attend training.
WHEN YOU WILL WORK
Your hours of work each month will vary depending on the
number of households you are assigned to interview. The work
will usually require evening and weekend work to meet
deadlines. You must be willing to work the hours necessary to
complete an assignment on schedule. Many positions will
require that you be willing to travel to a variety of
neighborhoods and to interview diverse groups. You need to be
available to work when the people you need to interview are
home, but generally no later than 9:00 p.m. Interviewing may
require driving in the evenings and during bad weather.
PAY

HOW CAN YOU QUALIFY FOR CENSUS WORK?
1. United States citizens will be given preference for census
jobs. However, noncitizens may be considered for
temporary appointments if qualified citizens are not
available, particularly in areas where bilingual ability is a
necessary qualification. You must present documentation
of employment eligibility. The types of acceptable
documentation are listed on the reverse side of this form.
2. You may be hired if you are 18 years old or older.
3. You must have a valid Social Security number.
4. Applicants must take and pass a written test of basic skills.
5. Most census jobs require the employee to conduct
face-to-face interviews with respondents. This involves
visiting respondents in a variety of residence types, asking
questions and recording responses.
6. Male applicants born after December 31, 1959, must
be registered with the Selective Service System.
7. If you have had a conviction of a violation of the law since
age 18 for something other than a minor traffic violation it
could be a basis for nonselection.
8. You may not engage in any partisan political activity while
on duty.
9. All non-census employment (including law and regulatory
enforcement jobs) will be reviewed on a case-by-case
basis for compatibility with Census Bureau employment.
10. Applicants must be available to work days, evenings, and
weekends. Since most people are not home during the
day, you will have to visit some homes during the evening
and on the weekends.

You will be paid for hours worked including time spent in
training. You also will be reimbursed for out of pocket
expenses, for telephone and other travel costs on official
business; such as parking fees, bus fares, etc. You also will be
reimbursed for authorized mileage when in training and
working. The method of payment is bi-weekly direct deposit into
your financial institution account.

For more information, contact:

BC-170A

FORM
(7-14-2008)

Instructions to prepare for the testing session
are on reverse side.

USCENSUSBUREAU
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How do I complete the BC-170A, Census Employment
Inquiry?
1. Print clearly using a black or blue pen. We
cannot accept your form if it is not legible.
Print neatly in uppercase. For example
2. Follow the instructions provided with every item. If you do not
answer all questions fully and correctly, you may delay the
processing of your application.
3. Enter one letter or number within each white block or complete
the information on the line provided.
Here are a few explanatory notes for some of the items:
Page 1
Section A – Applicant Personal Data
4. Enter your State postal abbreviation for the state in which you
live, for example, MS for Mississippi.
10a. Enter your Date of Birth. For example, enter July 6, 1952 as
follows:
Month
Day
Year

Page 2
Section C – Other Consideration
16a. Enter an (X) in the yes or no response box for: Are you
willing to work in the field? If you enter "yes" in the response
box, you will be considered for positions in the field. These
positions include working primarily outside the office
environment.
b. Enter an (X) in the yes or no response box for: Are you
willing to work in the office? If you enter "yes" in the
response box, you will be considered for positions in the
office. These positions include working primarily within the
office environment.
By entering a yes for both office and field positions, you
will be considered for positions in both those areas.

What is the test like?
Each applicant interested in Census Bureau employment must
take a written test. One such test is called the Field Employee
Selection Aid. It consists of 32 questions designed to measure
the knowledge, skills, and abilities, required to perform a
variety of census jobs. You will have 30 minutes to complete
the multiple choice test. Provided here are some sample
questions to help better prepare you for the test. If you pass
the written test, you will then participate in two interview
exercises.
The test is physically accessible to people with disabilities.
Requests for reasonable accommodations for persons with
disabilities (such as sign language interpretation) should be
directed to the contact office and phone number on the front of
this form.
Sample Questions
Review the numbers in Column A to those in Column B. Then
answer the question below.
Column A
Column B
85537
73358
75823
87537
87537
82357
82537
85537
73358
75823
Which number in Column A has no match?
(C) 97537
(A) 82537
(D) None of the above
(B) 85537
ANSWER A
Multiply the numbers below:
1.5 x 6.3
(A) .945
(C) 94.5
(B) 9.45
(D) 945
ANSWER B
Can I receive veterans’ preference?
If you served on active duty in the United States military and
were separated under honorable conditions, you may be
eligible for veterans’ preference. To receive 5-point veterans’
preference, applicants must bring a copy of a completed
DD-214, Certificate of Release or Discharge from Active
Duty,to the testing site. To receive 10-point veterans’
preference, applicants must also bring a completed SF-15,
Application for Veterans’ Preference, with the appropriate
documentation as shown on the reverse of the SF-15.

Identification you need to bring to the testing site
EMPLOYMENT ELIGIBILITY VERIFICATION – The following types of documentation can be used to prove identity and eligibility
requirements for employment. Provide one document from List A or one document from List B and from List C to meet Form I-9 requirements.
LIST A – Documents that Establish
Both Identity and Employment
Eligibility

1. U.S. Passport (unexpired or expired)
2. Permanent Resident Card or Alien
Registration Receipt Card (Form I-551)
3. Unexpired foreign passport, with a
temporary I-551 stamp.
4. Unexpired Employment Authorization
document that contains a photograph
(Form I-766, I-688, I-688A, I-688B)
5. An unexpired foreign passport with an
unexpired Arrival-Departure Record,
Form I-94, bearing the same name as
the passport and containing an
endorsement of the alien’s nonimmigrant
status, if that status authorizes the alien
to work for the employer

SPECIAL
NOTE

LIST B – Documents that Establish
Identity
OR 1. Driver’s license or ID card issued by a

LIST C – Documents that Establish
Employment Eligibility
AND 1. U.S. Social Security card issued by the

State or outlying possession of the
United States provided it contains a
photograph or information such as
name, date of birth, gender, height, eye
color, and address
2. ID card issued by federal, state, or local
government agencies or entities
provided it contains a photograph or
information such as name, date of birth,
gender, height, eye color, and address
3. School ID card with a photograph
4. Voter’s registration card
5. U.S. Military card or draft record
6. Military dependent’s ID card
7. U.S. Coast Guard Merchant Mariner Card
8. Native American tribal document
9. Driver’s license issued by a Canadian
government authority
For persons under age 18 who are unable
to present a document listed above.
10. School record or report card
11. Clinic, doctor, or hospital record
12. Day-care or nursery school record

Social Security Administration (other
than a card stating it is not valid for
employment)
2. Certificate of Birth Abroad issued by
the Department of State
(Form FS-545 or Form DS-1350)
3. Original or certified copy of a birth
certificate issued by a state, county,
municipal authority or outlying
possession of the United States
bearing an official seal
4. Native American tribal document
5. U.S. Citizen ID Card (Form I-197)
6. ID Card for use of Resident Citizen in
the United States (Form I-179)
7. Unexpired employment authorization
document issued by DHS(other than
those listed under List A)

• Form I-151 is no longer an acceptable List A document #5. However, Form I-551
remains an acceptable List A document #5.

FORM BC-170A (7-14-2008)

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Page 1
FORM BC-170A

OMB No.
U.S. DEPARTMENT OF COMMERCE

CENSUS EMPLOYMENT INQUIRY

(7-14-2008)

Economics and Statistics Administration

U.S. CENSUS BUREAU

Section A – APPLICANT PERSONAL DATA

1.

9.

Job Announcement Name and/or Job title:

Sex Mark (X) one box.
Female

2.

Male

10a. Date of birth

Social Security Number

Month

Day

Year

3. Name
Last Name

b. Place of birth
City

First Name

MI

11.
4.

State or Country

Are you a citizen or national of the United States?

Residence address
Street address or RFD number (Include apartment number, if any)

Yes
No – Specify country

12.
City

FOR MALES ONLY: If you are a male born after December 31,
1959, and you want to be employed by the federal government,
you must be registered with the Selective Service System.
Mark (X) one box.
I certify that I am registered.
I certify that I am not registered. If not, explain in item 34.

County

13.
State

5.

ZIP Code

Military Service
a. Do you claim veterans’ preference? Mark (X) one box.
No preference – Skip to item 14.
Yes – List period(s) of service

Mailing address (if different from item 3)
Street address or RFD number (Include apartment number, if any)

Month Year

Month Year
TO

Branch, Rank, Awards, Badges, or Campaign medals –
City

b.
State

Veterans’ preference categories? Mark (X) one box.
5-point preference – Attach your DD-214 or other proof

ZIP Code

6.

Intersecting streets nearest your home

7.

E-mail address

8.

Telephone number(s)
Area code Number

10-point preference – Follow instruction below
If you claim 10-point preference, you must complete a
Standard Form 15, which is available at any Federal Job
Information Center. ATTACH THE COMPLETED SF-15 TO
THIS APPLICATION, INCLUDE THE PROOF REQUESTED ON
THE REVERSE SIDE OF THE SF-15. Indicate the type of
10-point preference you qualify for by marking (X) one
of the following:
10-point (disability) pref.
10-point (compensable disability) pref. – less than 30%
Mark (X)
one box
(H) (W) (C)

10-point (compensable disability) pref. – 30% or more
10-point (other) pref. (use when you are a spouse,
widow, or mother of a disabled veteran)

Day

c.

Evening

Honorable or general under honorable conditions

Other
phone

Other – Explain in item 34.
A. Location

FOR
OFFICE
USE
ONLY

Kind of discharge? Mark (X) one box.

B. FIPS State

C. FIPS County

D. Census Tract

.

Office
or LCO
F. Scores

E. Census Block

Final Score

Basic skills test
Mock interview

G. I-9
Code

List A:

List B:

List C:

H. Veteran’s proof

I. Language code(s)

J. Disposition

Verified &
attached

Structured interview

NOTE – THE ACCURACY OF YOUR STATEMENTS WILL BE VERIFIED.

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Section A – APPLICANT PERSONAL DATA – Con.

17.

Have you ever worked for the Census Bureau?
If yes, indicate dates of employment and title of
position in item 34.

Some high school – Did not graduate

18.

High school diploma/GED

Are you now employed by a federal, state, local or
tribal government?
Yes
No

Technical degree/Trade school degree or certificate

If yes, indicate name
of agency, date and
grade level.

Associate’s degree
Bachelor’s degree
Master’s degree

19.

Do you receive retirement or have you ever applied for retirement
pay, pension, or other pay based on federal civilian or District of
Columbia government service? If yes, explain in item 34.

20.

Do any of your relatives work for the Census Bureau?
Include – Father, mother, husband, wife, son, daughter, brother, sister,
uncle, aunt, first cousin, nephew, niece, father-in-law, mother-in-law,
son-in-law, daughter-in-law, stepfather, stepmother, stepson,
stepdaughter, stepbrother, stepsister, half brother, and half sister.
Yes – Provide location (city and state) and position.

Doctoral degree

b. Complete when a Technical/Trade school program,
an Associate’s, Bachelor’s, Master’s or
Doctoral degree is selected in 13a.

No

Yes

14a. Education – Mark (X) highest education level

Degree
(if any)

Year
received

Yes

Name of
institution

No

City
State or
country

Section B – RECRUITING SOURCES

15.

No
Hiring may be based in part on the hours you are available to work.
Indicate your availability by placing "X" in the appropriate box(es) for each
day.
Sun Mon Tues Wed Thurs Fri
Sat

21.

How did you hear about census job opportunities? Mark (X)
multiple sources if applicable
Poster/flyer
Community or organization newsletter/newspaper/leader
Federal, state, tribal employment office/
Job service and information center
Speech/presentation by Census employee
Friend or relative working for Census
Toll-free Census number or job line

a. Any hours
b. Morning

(8 a.m. – 12 noon)

c. Afternoon

(12 noon – 4 p.m.)

d. Evening

(4 p.m. – 9 p.m.)

22.

Total hours per week you are willing to work up to
and including 40 hours.

Census job mailing or postcard
Friend or relative not working for Census
Job Fair
Newspaper – advertisement
Newspaper – article

Section D – LANGUAGES

23.

Some census jobs require census employees to conduct the census
interview by reading and recording responses to questions in a language
other than English. The census employee must also be able to convince
individuals who speak no English to respond to the interview by
explaining the purpose and importance of the census. Employees will
receive Census training, but not language training.
Are you fluent enough in any specific language to hold a conversation, to
easily read and record responses, as well as to respond to questions in that
language with individuals who speak no English? If so, please list the
language(s) below and mark (X) to all that apply.

Radio
Internet/E-Mail
School or college
Business/private company
TV
Other – Specify

Section C – OTHER CONSIDERATION

16a.

Are you willing to work in the field? Field work includes positions
primarily outside the office environment and may require you to travel to
all types of neighborhoods.
Yes

b.

Are you willing to work in the office? (Limited number of these jobs
available.)
Yes

c.

No

No

Will you be available to attend a 3–5 day training session?
Yes

No

d.

Do you have a land line telephone?

e.

Yes
No
Do you have computer or data entry experience?
Yes

No

Language(s)

Speak

Read

Write

Section E – TRANSPORTATION

24a.

Indicate the type(s) of transportation available for your use –
Mark (X) all that apply.
Automobile
4-Wheel drive
Airplane
Boat
ATV (All terrain
vehicle)
Other – Describe
None

b. Do you have a valid driver’s license?
Yes

No

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28a.

Section F – PRIOR WORK EXPERIENCE

25.
26.

If you have never worked, mark (X) here
and SKIP to item 29.
Can we contact your most recent employer?

b.

Yes

27a.

No
Name of your present or most recent employer

Name of your next most recent employer

Supervisor’s name (Last name, first name, middle initial)
Last Name

First Name

b.

Supervisor’s name (Last name, first name, middle initial)
Last Name

c.
First Name

c.

MI

Address of next most recent employer

MI

Address of your present or most recent employer

City

State

ZIP Code

City

State

Telephone number
Area code Number

e.

Date of employment
Month
Day
Year

ZIP Code

d.

Telephone number
Area code Number

e.

Date of employment
Month
Day
Year

Month

d.

Day

TO

TO
Month

Year

Day

Year

f. Title of position

f. Title of position

g.

Salary

.

$

g.

Salary

Hourly

h.

Hourly

.

$

Weekly

Monthly

Yearly

h.

Describe duties

j.

Reason for leaving

Yearly

Did you supervise?

No

Yes

i.

Monthly

Yes

Did you supervise?

No

Weekly

i.

Describe duties

j.

Reason for leaving

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Section G – BACKGROUND INFORMATION
Answer all questions in items 29 through 33 below. Read each statement carefully before responding.

29.

During the past 5 years, have you been fired from any job for any reason, did you quit after being told that you
would be fired, or did you leave any job by mutual agreement because of specific problems, or were you debarred from
Federal employment by the Office of Personnel Management or any other agency?
If "YES," use 34 (below) to write for each job a) the name of the employer; b) the approximate date you left the job, and
c) an explanation of the problem and the reason for leaving.

Mark (X) one
Yes

No

When answering questions 30 through 33 you may omit: 1) traffic fines of $300 or less; 2) any violation of law committed before your 16th
birthday, 3) any violation of law committed before your 18th birthday, if finally decided in juvenile court or under a Youth Offender law; 4) any
conviction set aside under the Federal Youth Corrections Act or similar state law; 5) any other conviction for which the record was expunged
under federal or state law. NOTE: You must include convictions resulting from a plea of nolo contendere (no contest).
Important note about questions 30 through 32. We will consider the date, facts, and circumstances of each event you
list. In most cases you can still be considered for federal jobs. However, if you fail to tell the truth or fail to list all relevant
events, this failure may be grounds for not hiring you, for firing you after you begin work, or for criminal prosecution [18
U.S.C. 1001].

30.

During the last 10 years, have you been convicted, been imprisoned, been on probation, or been on parole?
(Includes felonies, firearms or explosive violations, misdemeanors, and all other offenses.) If "YES" use item 34 to provide the
date, explanation of the violation, place of occurrence and the name and address of the police department or court involved.
[A felony is defined as any violation of law punishable by imprisonment of longer than one year, except for violations
called misdemeanors under state law which are punishable by imprisonment of two years or less.]
Yes

No

31.

Are you now under charges for any violation of law? If "YES" use item 34 to provide the date, explanation of the violation,
place of occurrence, and the name and address of the police department or court involved.

Yes

No

32.

Have you been convicted by a military court-martial in the past 10 years? If no military service, answer "NO." If
"YES" use item 34 to provide the date, explanation of the violation, place of occurrence, and the name and
address of the military authority or court involved.

Yes

No

Yes

No

33.

Are you delinquent on any federal debt? (Include delinquencies arising from federal taxes, loans, overpayment of
benefits, and other debts to the U.S. Government plus defaults on federally guaranteed or insured loans such as student
and home mortgage loans.) If "YES", use item 34 to provide the type, length, and amount of the delinquency or default,
and steps that you are taking to correct the error or repay the debt.

34.

EXPLANATIONS OR ANSWERS TO ITEMS 1 THROUGH 33 – Attach additional listing if needed.

Section H – PRIVACY ACT STATEMENT
Solicitation of this information is authorized by section 23 of title 13, U.S. Code, which authorizes temporary appointments in the
Census Bureau. The information will be used primarily to determine your qualifications for employment and may be used also to
identify you to other sources asked to comment on your qualifications, e.g., educational institutions, former employers, and law
enforcement agencies, or to a court during legal proceedings.
We must have your Social Security Number (SSN) to keep our records straight because other people may have the same name and
birthdate. The SSN has been used to keep records since 1943, when Executive Order 9397 asked agencies to do so. The furnishing of
all the information is voluntary, but failure to provide any part or all of the data requested will result in your receiving no further
consideration for employment.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to: Paperwork Project 0607-0139, U.S. Census Bureau, 4700 Silver Hill Road, Stop 1500,
Washington, DC 20233-1500. You may e-mail comments to [email protected]; use "Paperwork Project 0607-0139" as the subject.
The eight digit OMB control number on the first page of this form confirms our authority to collect this information.

Section I – SIGNATURE, CERTIFICATION, AND RELEASE OF INFORMATION
YOU MUST SIGN THIS APPLICATION IN DARK INK. Read the following carefully before you sign. A false statement on any part of
your application may be grounds for not hiring you, or for firing you after you begin work. Also, you may be punished by fine
or imprisonment (U.S. Code, Title 18, Section 1001). I understand that any information I give may be investigated as allowed by
law or Presidential order. I consent to the release of information about my ability and fitness for Federal employment by
employers, schools, law enforcement agencies and other individuals and organizations, to investigators, personnel staffing
specialists, and other authorized employees of the Federal Government. I certify that, to the best of my knowledge and belief,
all of my statements are true, correct, complete, and made in good faith.
Signature

Date signed

Print name
FORM BC-170A (7-14-2008)

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