BC-170B Census Employment Inquiry

Census Taker Jobs
U.S. Department of Commerce • Economics and Statistics Administration • U.S. CENSUS BUREAU

The Census Bureau is an Equal Opportunity Employer.
HOW CAN I QUALIFY FOR CENSUS WORK?

WORK A FEW WEEKS AS A CENSUS TAKER
In the near future, the U.S. Census Bureau will conduct a
special census in this area. Your community has requested it
and will incur the cost. Local residents will be needed to work
as census takers. Census takers visit households and collect a
few facts about each member such as name, age, relationship
to the householder, etc.
WHY A SPECIAL CENSUS?
Local governments consider up-to-date population information
beneficial to residents to determine the allocation of state
funds to communities, improved ability to plan for schools,
better transportation, and for many other purposes. Unless a
special census is taken to provide a more recent population
figure, the 2010 Census count is used. Your community may
benefit from this updated official population count.
YOUR TRAINING
Before you go to work, you will attend a training session where
you will learn the use of census forms and census techniques
such as interviewing and map reading. In most cases, your
supervisor will train you, assign and review your work, and
answer questions.

1. United States citizens will be given preference for
census jobs. However, noncitizens may be considered
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 page.
2. You must be 18 or older to be hired.
3. You must have a valid Social Security Number.
4. Applicants must take a written test of basic skills (in
some areas, the test may be taken in Spanish).
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.

YOUR PAY
You will be paid for actual hours of work including time spent
in training. You will get specific information about pay from the
census supervisor.
YOUR DUTIES
When you have successfully completed your training, you will
be given several neighborhood blocks called an "Assignment
Area." Normally, your first assignment will be the area in which
you live. You will be provided a map of each Assignment Area
and the necessary census forms and materials to do the job.
Most of the jobs are in the field, and require you to locate and
interview households and record information about the
residents. When you accept your appointment, you assume an
obligation to stay with the job until your assignment is
completed.
The information you collect is confidential and must
not be disclosed to anyone who has not sworn to
protect Census Bureau information.
For more information, contact:

BC-170B

FORM
(12-28-2007)

7. You should have a satisfactory work record for the
past 5-years. Poor job performance or misconduct on
a previous job could be a basis for nonselection.
8. 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.
9. You may not engage in any partisan political activity
while on duty.
10. 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.
11. Applicants must be available to work days, evenings,
and weekends. Since not all people will be home during
the day, you will have to visit some homes during the
evening and on the weekends. This will usually be not
later than 9:00 p.m.

Instructions on the types of identification to
bring to the testing session are on reverse side.

USCENSUSBUREAU
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How do I complete the BC-170, 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

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 28 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. You may also
request a practice test to help prepare for the test.
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

Section A – Applicant Personal Data
3. Enter the State postal abbreviation for the state in
which you live, for example, MS for Mississippi.
8. Enter your Date of Birth. For example, enter
July 6, 1952 as follows:
Month
Day
Year

Which number in Column A has no match?
(C) 97537
(A) 82537
(D) None of the above
(B) 85537

Page 2
Section C – Application Data
14a. 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.

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
LIST B – Documents that Establish
Identity and Employment Eligibility
Identity
1. U.S. Passport (unexpired or expired)
OR 1. Driver’s license or ID card issued by a

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. 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.

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

Social Security Administration (other
than a card stating it is not valid for
employment)
2. Certification 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)

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
FORM BC-170B (12-28-2007)

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NOTE – THE ACCURACY OF YOUR STATEMENTS WILL BE VERIFIED.

OMB No. 0607-0139
U.S. DEPARTMENT OF COMMERCE

FORM BC-170B
(12-28-2007)

Economics and Statistics Administration

CENSUS EMPLOYMENT INQUIRY

U.S. CENSUS BUREAU

Section A – APPLICANT PERSONAL DATA

1.

Social Security Number

8.

Sex Mark (X) one box.

9.

Date and place of birth
a. Date of birth
Month
Day
Year

Male

Female

2. Name
Last Name

First Name

3.

MI

b. Place of birth
City

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

State or country

10.
City

I certify that I am registered.
I certify that I am not registered. If not, explain in item 35.

County

State

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.

11. Are you a citizen or national of the United States?
Yes
No – Are you a lawful permanent resident?

ZIP Code

Yes – Specify alien No.

4.

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

No

12.

Military Service
a. Do you claim veterans’ preference? Mark (X) one box.
No preference – Skip to item 13a.

City

State

Yes – List period(s) of service
Month Year

Month

Year

TO

ZIP Code

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

5.

Intersecting streets nearest your home

b.

6.

E-mail address

7.

Telephone number(s)
Area code
Number

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

Mark (X)
one box
(H)

Day

10-point (compensable disability) pref. – less than 30%
10-point (compensable disability) pref. – 30% or more

(W) (C)

10-point (other) pref. (use when you are a spouse,
widow, or mother of a disabled veteran)

Evening

c.

Kind of discharge? Mark (X) one box.
Honorable or general under honorable conditions
Other – Explain in item 35.

Other
phone
B. FIPS State

A. Location

FOR
OFFICE
USE
ONLY

C. FIPS County D. Census Tract

.

Office
or LCO
F. Employee class

E. Census Block

G. I-9
Code

List A:

List B:

List C:

H. Veteran’s proof

I. Language code(s)

J. Disposition

Verified &
attached

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Section A – APPLICANT PERSONAL DATA – Con.

18.

13a. Education – Mark (X) highest education level.

Yes

Some high school – Did not graduate
High school diploma/GED
Technical degree/Trade school degree or certificate
Associate’s degree
Bachelor’s degree
Master’s degree
Doctoral degree

19.

Degree
(if any)

No

Are you now employed by a Federal, state, local or tribal
government? If yes, indicate date, and grade level in item 35.
Yes
No
Name of agency

20.

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

Have you ever worked on previous census operations?
If yes, indicate dates of employment in item 35.

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?
Yes – Explain in Item 35.

Year
received

21.

Name of
institution

No

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.

City
State or
country

No

22.
Section B – RECRUITING SOURCES

14.

How did you hear about census job opportunities?
Mark (X) one box only.

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

a. Any hours
b. Morning

Poster/flyer
Community or organization newsletter/newspaper/leader
Federal, state, tribal employment office/
Job service and information center
Speech/presentation by Census employee

(8 a.m. – 12 noon)

c. Afternoon

(12 noon – 4 p.m.)

d. Evening
(4 p.m. – 9 p.m.)

Friend or relative working for Census
Toll-free Census number or job line
Census job mailing or postcard
Friend or relative not working for Census
Job Fair
Newspaper – advertisement
Newspaper – article
Radio
Internet/E-Mail
School or college
Business/private company
TV
Other – Specify

23.

Total hours per week you are willing to work.You may only
work up to 40 hours per week.

Section D – LANGUAGE SKILLS

24.

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.
Language(s)

Speak Read

Write

Section C – APPLICATION DATA
Most positions require dealing with the public and knocking
on doors to collect personal information, which may not be
discussed or shared with anyone except for sworn Census
Bureau employees.

15.

Section E – TRANSPORTATION

Are you willing to work in the field, verifying household
address listings and knocking on doors to collect
information?
Yes
No

25a.

Automobile
4-Wheel Drive
Airplane
Boat
ATV (All terrain
vehicle)
Other – Describe
None

Most office positions involve working with computers.

16.

Are you willing to work in the office? (There are a
limited number of these jobs available.)
Yes
No

17.

Do you have personal computer experience?
Yes
No

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Indicate the type(s) of transportation available for
your use – Mark (X) ALL that apply.

b.

Do you have a valid driver’s license?
Yes

No

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29a. Name of your next most recent employer

Section F – PRIOR WORK EXPERIENCE

26.

If you have never worked, mark (X) here
and SKIP to item 30.

27.

Can we contact your most recent employer?

b.

Yes

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

No

28a. Name of your present or most recent employer

b.

First Name

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

First Name

MI

c. Address of next most recent employer

MI
City

c. Address of your present or most recent employer
State

ZIP Code

d. Telephone number

City

Area code

State

Number

ZIP Code

e. Date of employment
Month

Day

Month

Day

Year

d. Telephone number
Area code

Number
TO
Year

e. Date of employment
Month

Day

Year

f. Title of position and kind of work done,
explain work in item 35.
TO
Month

Day

Year

g.
f. Title of position and kind of work done,

Salary

.

$

explain work in item 35.

Hourly

g.

Monthly

Yearly

h. Did you supervise?

Salary

Yes

.

$
Hourly

Weekly

Weekly

No
Monthly

Yearly

i.

h. Did you supervise?

Reason for leaving

Yes
No

i.

Reason for leaving

FORM BC-170B (12-28-2007)

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Section G – BACKGROUND INFORMATION
Answer all questions in items 30 through 34 below. Read each statement carefully before responding.

30. During the past 5 years, have you been fired from any job for any reason, did you quit after being told that you

Mark (X) one

would be fired, or did you leave 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 35 (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.

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

When answering questions 31 through 34 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 31 through 34. 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].

31. During the last 10 years, have you been convicted, been imprisoned, been on probation, or been on
parole? (Include felonies, firearms or explosive violations, misdemeanors, and all other offenses.) If "YES" use item 35 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 violation
called midemeanors under State law which are punishable by imprisonment of two years or less.]

32. Are you now under charges for any violation of law? If "YES" use item 35 to provide the date, explanation of the violation, place of
occurrence, and the name and address of the police department or court involved.

33. Have you been convicted by a military court-martial in the past 10 years? If no military service, answer "NO." If
"YES" use item 35 to provide the date, explanation of the violation, place of occurrence, and the name and address of
the military authority or court involved.

34. 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 35 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.

35.

EXPLANATIONS OR ANSWERS TO ITEMS 1 THROUGH 34 – 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, 4600 Silver Hill Road, 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
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