Form OPM Form 1203-FX OPM Form 1203-FX Occupational Questionnaire

Form Approved
OMB No. 3206-0040
Expires: 01/31/2013

U.S Office of Personnel Management
Occupational Questionnaire – OPM Form 1203-FX

Instructions:
The Occupational Questionnaire OPM Form 1203-FX is a scan form to be used by applicants when applying for
employment. This cover sheet provides the instructions for completing the OPM Form 1203-FX as well as information
on the Privacy Act and Public Burden Statements. The scan form itself consists of 6 pages. When submitting the
completed 1203-FX, do not include this cover page.
Follow the instructions in the job announcement to complete the attached form. To ensure accuracy:
-

PRINT characters in block style as shown in the examples below.
PRINT your responses in the boxes, lines and/or blacken in the appropriate circles.
Do not write outside the boxes.
Use black ink.

You may obtain an electronic copy of this form at www.opm.gov/forms.

Privacy Act Statement
The U.S. Office of Personnel Management (OPM) and other Federal agencies rate applicants for Federal jobs under the
authority of sections 1104, 1302, 3301, 3304, 3320, 3361, 3393, and 3394 of title 5 of the United States Code. Section
1104 of title 5 allows the OPM to authorize other Federal agencies to rate applicants for Federal jobs. We need the
information you provide in this form to determine how well your education and work skills qualify you for a Federal job.
We also need information on matters such as citizenship and military service to determine whether you are affected by
laws we must follow in deciding who may be employed by the Federal government.
We request your Social Security Number (SSN) under the authority of Executive Order 9397 and Public Law 104-134.
Giving us your SSN or any of the other information is voluntary. However, we cannot process your application, which
is the first step toward getting a job, if you do not give us the information we request.
Public Burden Statement
We estimate the public reporting burden for this collection is 45 minutes, including time for reviewing instructions,
searching existing data sources, gathering data, and completing and reviewing the information. Send comments
regarding the burden statement or any other aspect of the collection of information, including suggestions for reducing
this burden to: U.S. Office of Personnel Management (OPM), Automated Systems Management Group, Occupational
Questionnaire (3206-0040), Washington, DC 20415-7900. The OMB number, 3206-0040, is currently valid. OPM may
not collect this information, and you are not required to respond, unless this number is displayed.
Do not send completed application forms to this address. Follow directions provided in the job announcement(s).

U.S. Office of Personnel Management
Previous Edition Usable

COVER PAGE

OPM Form 1203-FX
Revised July 2009

Form Approved

U.S. Office of Personnel Management OMB No. 3206-0040
Occupational Questionnaire - OPM Form 1203-FX
Draft
Please complete the Social Security Number (SSN) and Vacancy Identification Number fields on each page of this application form. If this
information is not completed, we cannot process your application. SSN is collected under the authority the Privacy Act, which can be reviewed
along with the Public Burden Statement on the cover page of this form. You must return all 6 pages.

Social Security Number

-

Vacancy Identification Number
(For example,
AB123456)

-

Follow the instructions in the job announcement. To ensure accuracy:
- PRINT characters in block style as shown in the examples below.
- PRINT your responses in the boxes and/or blacken in the appropriate circles.
- Do not write outside the boxes.
- Use black ink.
You may obtain an electronic copy of this form at www.opm.gov/forms.

Shade circle like this:
Not like this:

1.

Print title of job applying for

2.

Biographic Data

A. First Name

B. Middle Initial

C. Last Name

D. Street Address (house number, street, apartment number, where you want to receive mail)

Use Standard State Postal Codes
If outside the United States of
America, and you do not have a military
address, print "OV" in State and fill in Country,
leaving Zip Code blank.

E. City

G. Zip Code

F. State (abbreviations).

+ 4 (optional)

H. Country

I. Telephone Number
J. Contact Time
Day
Night
Either
Use numbers only - no punctuation or spaces. Include area code if within the United States of America.

3. E-Mail Address (print your complete e-mail address):

U.S. Office of Personnel Management
Previous Edition Usable

Page 1 of 6

OPM Form 1203-FX
Revised July 2009

Draft
Please complete the Social Security Number (SSN) and Vacancy Identification Number fields on each page of this application form. If this
information is not completed, we cannot process your application. SSN is collected under the authority the Privacy Act, which can be reviewed
along with the Public Burden Statement on the cover page of this form. You must return all 6 pages.

Social Security Number

4.

Vacancy Identification Number
(For example,
AB123456)

-

Work Information (if applicable) A. Place of Employment

B. Work Address

C. City

Zip Code

D. State

+ 4 (optional)

Use Standard State Postal Codes
(abbreviations). If outside the United States of
America, and you do not have a military
address, print "OV" in State and fill in Country,
leaving Zip Code blank.

F. Country

G. Telephone Number

Extension (if applicable)

Use numbers only - no punctuation or spaces. Include area code if within the United States of America.

5. Employment Availability - Are you available for: 6. Citizenship
YN
A. Full-time employment
- 40 hours per week?
B. Part-time employment of
- 16 or fewer hrs/week?
- 17 to 24 hrs/week?
- 25 to 32 hrs/week?
C. Temporary employment lasting
- less than 1 month?
- 1 to 4 months?
- 5 to 12 months?
D. Jobs requiring travel away from home for
- 1 to 5 nights/month?
- 6 to 10 nights/month?
- 11 plus
E. Other employment questions (see instructions)
YN
YN
Question 1.
Question 4.
Question 2.
Question 5.
Question 6.
Question 3.
U.S. Office of Personnel Management

Are you a citizen of the United States of America?
Yes
No

7. Background Information
(see job announcement instructions)
Y N
Y N
Question 1.
Question 4.
Question 2.
Question 5.
Question 3.
Question 6.

8. Other Information

(see job announcement instructions)
A. Gender
B.

Female

Date of Birth (mm/dd/yyyy)

/
Page 2 of 6

Male

/
OPM Form 1203-FX
Revised July 2009

Draft
Please complete the Social Security Number (SSN) and Vacancy Identification Number fields on each page of this application form. If this
information is not completed, we cannot process your application. SSN is collected under the authority the Privacy Act, which can be reviewed
along with the Public Burden Statement on the cover page of this form. You must return all 6 pages.

Social Security Number

-

Vacancy Identification Number
(For example,
AB123456)

10.

9. Languages (see job announcement instructions)

Lowest Grade

11. Miscellaneous Information

13.Test Location

12. Special Knowledge

When entering dates in the following fields,
please use the format: mm/dd/yyyy

14.Veterans' Preference
No Preference Claimed

15. Dates of Active Duty - Military Service

(skip if no veterans' preference is claimed in block 14)

5 Points Preference Claimed
10 Point Preference - You must submit a completed Standard
Form 15, Application for 10-Point Veterans' Preference.

10 Points Preference Claimed
(award of a Purple Heart or service-connected disability
of less than 10%)

From:

/

/

To:

/

/

16. Availability Date

10 Points Compensable Disability Preference Claimed

/

(disability rating of at least 10% and less than 30%)

/

17. Service Computation Date

10 Points Other

/

(spouse, widow, widower, mother preference claimed)

10 Points Compensable Disability Preference Claimed

/

18. Other Date

/

(disability rating of 30% or more)

/

19. Job Preference (see job announcement instructions)
1
2
3
4
5

6
7
8
9
10

11
12
13
14
15

16
17
18
19
20

21
22
23
24
25

26
27
28
29
30

U.S. Office of Personnel Management

31
32
33
34
35

36
37
38
39
40

41
42
43
44
45

Page 3 of 6

46
47
48
49
50

51
52
53
54
55

56
57
58
59
60

61
62
63
64
65

66
67
68
69
70

OPM Form 1203-FX
Revised July 2009

Draft
Please complete the Social Security Number (SSN) and Vacancy Identification Number fields on each page of this application form. If this
information is not completed, we cannot process your application. SSN is collected under the authority the Privacy Act, which can be reviewed
along with the Public Burden Statement on the cover page of this form. You must return all 6 pages.

Social Security Number

20.

Vacancy Identification Number
(For example,
AB123456)

-

Occupational Specialties (see job announcement instructions)
1

2

3

4

5

6

7

8

9

10

21. Geographic Availability (see job announcement instructions; numeric only)
1

6

2

7

3

8

4

9

5

10

22. Indicate if you are requesting consideration for either the 24. Personal Background Information
Career Transition Assistance Plan (CTAP)
Interagency Career Transition Assistance Plan (ICTAP)

23. Job Related Experience
(see job announcement instructions)
Years:

Months:

U.S. Office of Personnel Management

Page 4 of 6

(see job announcement instructions)
1
11
2
12
3
13
4
14
5
15
6
16
7
17
8
18
9
19
10
20

OPM Form 1203-FX
Revised July 2009

Draft

25. Occupational Questions (see job announcement instructions)

Please complete the Social Security Number (SSN) and Vacancy Identification Number fields on each page of this application form. If this
information is not completed, we cannot process your application. SSN is collected under the authority the Privacy Act, which can be reviewed
along with the Public Burden Statement on the cover page of this form. You must return all 6 pages.

Social Security Number

-

A B C D E F G H I
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.

A B C D E F G H I
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

A B C D E F G H I
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.

A B C D E F G H I
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.

A B C D E F G H I
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.

(For example,
AB123456)

-

A B C D E F G H I
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Vacancy Identification Number

A B C D E F G H I
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.

A B C D E F G H I
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.

U.S. Office of Personnel Management

A B C D E F G H I
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.

Page 5 of 6

OPM Form 1203-FX
Revised July 2009

25.

Draft

Occupational Questions (continued)

Please complete the Social Security Number (SSN) and Vacancy Identification Number fields on each page of this application form. If this
information is not completed, we cannot process your application. SSN is collected under the authority the Privacy Act, which can be reviewed
along with the Public Burden Statement on the cover page of this form. You must return all 6 pages.

Social Security Number

-

A B C D E F G H I
121.
122.
123.
124.
125.
126.
127.
128.
129.
130.

A B C D E F G H I
101.
102.
103.
104.
105.
106.
107.
108.
109.
110.

A B C D E F G H I
151.
152.
153.
154.
155.
156.
157.
158.
159.
160.

A B C D E F G H I
131.
132.
133.
134.
135.
136.
137.
138.
139.
140.

A B C D E F G H I
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.

(For example,
AB123456)

-

A B C D E F G H I
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.

Vacancy Identification Number

A B C D E F G H I
161.
162.
163.
164.
165.
166.
167.
168.
169.
170.

A B C D E F G H I
141.
142.
143.
144.
145.
146.
147.
148.
149.
150.

A B C D E F G H I
171.
172.
173.
174.
175.
176.
177.
178.
179.
180.

You have now completed the OPM Form 1203-FX. When submitting, do not include the cover page. Only submit pages numbered 1 through 6.

U.S. Office of Personnel Management

Page 6 of 6

OPM Form 1203-FX
Revised July 2009