BC-170B Census Employment Inquiry-BC170B

Census Jobs!
U.S. DEPARTMENT OF COMMERCE • Economics and Statistics Administration • U.S. CENSUS BUREAU

The Census Bureau is an
Equal Opportunity Employer
A UNIQUE OPPORTUNITY: EARN MONEY WHILE
YOU SERVE YOUR COMMUNITY
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.
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.

HOW CAN YOU QUALIFY FOR CENSUS WORK?
1. Noncitizens will only be considered for census jobs 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 may be hired if you are 18 years or older. If you
are under 18 and a function of the job is to drive, then
you cannot be hired. (Those ages 16 and 17 may be
hired for positions not involving driving so long as they
meet state and local employment requirements.)
3. You must have a valid Social Security Number.
4. Applicants must take a written test of basic skills. The
test may be taken in Spanish, upon request, along with
an English Proficiency Test.
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. The Census Bureau performs criminal background
checks and reviews criminal records (including
fingerprinting) as part of assessing applicants’ past
conduct and suitability for employment.

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.
DUTIES
When you have successfully completed your training, you
will be given several neighborhood blocks called
"Assignment Areas". 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.

8. You will 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 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 no
later than 9:00 p.m. You generally will have flexibility to
choose which hours to work during these productive
time periods.
For more information, contact:

The information you collect is confidential and
must not be disclosed to anyone who has not
sworn to protect Census Bureau information.

CONTINUE on reverse side

BC-170B

FORM
(6-23-2011)

DRAFT #7 (06/23/2011)

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

BC-170B, Page 1 Base copy, solid Black ink

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How do I complete the BC-170B, 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 3
Section A – Applicant Personal Data
3. Enter your street address followed by your city, county, and
state. Enter the state postal abbreviation for the state in which
you live, for example, MS for Mississippi.
7. Enter your telephone number(s) and Mark (X) box(es)
H – home, W – work, or C – cell
9. Enter your Date of Birth. For example, enter July 6, 1952 as
follows:
Month
Day
Year

Page 4
Section C – Application Data
15. 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.
16. 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 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
75823
87537
85537
73358
82537
85537
87537
82357
73358
75823
Which number in Column A has no match?
(A) 82537
(C) 97537
(B) 85537
(D) None of the above
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

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

1. U.S. Passport or Passport Card
2. Permanent Resident Card or Alien
Registration Receipt Card (Form I-551)
3. Foreign passport that contains a temporary
I-551 stamp or temporary I-551 printed
notation on a machine-readable immigrant
visa
4. Employment Authorization Document
that contains a photograph (Form I-766)
5. In the case of a nonimmigrant alien
authorized to work for a specific
employer incident to status, a foreign
passport with Form I-94 or Form I-94A
bearing the same name as the passport
and containing an endorsement of the
alien’s nonimmigrant status, as long as
the period of endorsement has not yet
expired and the proposed employment is
not in conflict with any restrictions or
limitations identified on the form.
6. Passport from the Federated States of
Micronesia (FSM) or the Republic of the
Marshall Islands (RMI) with Form I-94 or
Form I-94A indicating nonimmigrant
admission under the Compact of Free
Association Between the United States
and the FSM or RMI

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

LIST C – Documents that Establish
Employment Eligibility
AND 1. Social Security Account Number card

other than one that specifies on the
face that the issuance of the card
does not authorize employment in the
United States
2. Certificate of Birth Abroad issued by
the Department of State
(Form FS-545)
3. Certification of Report of Birth issued
by the Department of State
(Form DS-1350)
4. Original or certified copy of birth
certificate issued by a state, county,
municipal authority, or territory of the
United States bearing an official seal
5. Native American tribal document
6. U.S. Citizen ID Card (Form I-197)
7. Identification Card for Use of Resident
Citizen in the United States
(Form I-179)
8. Employment authorization document
issued by the Department of
Homeland Security

FORM BC-170B (6-23-2011)

BC-170B, Page 2 Base copy, solid Black ink

BC-170B, Page 2 Overlay, Pantone 306 (20% and 100%)

NOTE – THE ACCURACY OF YOUR STATEMENTS WILL BE VERIFIED.
FORM BC-170B
(6-23-2011)

OMB No. 0607-0139

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS EMPLOYMENT INQUIRY

Job Announcement No.

U.S. CENSUS BUREAU

Section A – APPLICANT PERSONAL DATA

1.

8.

Social Security Number

Sex Mark (X) one box.
Male

Female

9.

2. Name
Last Name

First Name

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

b. Place of birth

MI

City

3.

Residence address

State or country

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

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

City
No
County

State

4.

11.
ZIP Code

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 32.

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

12.

Military Service
a. Do you claim veterans’ preference? Mark (X) one box.
No preference – Skip to Item 13a.
Yes – List period(s) of service
Month

Year

Month

Year

TO

City

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

ZIP Code

b.
5.

Intersecting streets nearest your home

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) (W) (C)

Day

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

Evening

c.

Kind of discharge? Mark (X) one box.
Honorable or general under honorable conditions
Other – Explain in Item 32.

Other
phone
A. Location

FOR
OFFICE
USE
ONLY

B. FIPS
State

C. FIPS
County

D. Census Tract

Office
or LCO
G. I-9
Code

E. Census Block

.
List A:

List B:

List C:

I. Language code(s)

H. Veteran’s proof
Verified & attached

F. Test information
Non-Supervisory
Supervisory
Raw
score
Test
date

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Section A – APPLICANT PERSONAL DATA – Con.

19.

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

Yes – Name of agency
No

20.

Degree
(if any)

Are you now employed by a law enforcement agency?
Yes – Name of agency
No

21.

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

Are you now employed by a federal, state, local or tribal
government? – If yes, indicate date of hire and current grade
level in Item 32.

Do you have supervisory experience?
Yes – Describe in Item 32.

Year
received

22.

Do you receive retirement or have you ever applied for
retirement pay, pension, or other pay based on
nonmilitary, federal civilian, or District of Columbia
Government service?

23.

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,
brother-in-law, sister-in-law, son-in-law, daughter-in-law, stepfather,
stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother,
and half sister.

Name of
institution

Yes – Explain in Item 32.
City
State or
country

Section B – RECRUITING SOURCES

14.

Poster
Community or organization newsletter/newspaper/leader
Federal, state, tribal employment office/
Job service and information center
Census Recruiter
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
Census Job Website
TV
Brochure/Hand-out
Other – Specify

No

24.

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

(8 a.m. – 12 noon)

c. Afternoon

(12 noon – 4 p.m.)

d. Evening

(4 p.m. – 9 p.m.)
Census field work will usually require you to work evenings and
weekends.

Section D – LANGUAGE SKILLS

25.

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)

Most field 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. Are you willing to work in the field, verifying household
address listings and knocking on doors to collect
information?

17.
18.

use – Mark (X) ALL that apply.
Automobile
4-Wheel Drive
Airplane
Boat
ATV (All terrain vehicle)
Other – Describe
None

No

Do you have computer or data entry experience?
No

Have you ever worked on previous census operations?
Yes

No

FORM BC-170B (6-23-2011)

BC-170B, Page 4 Base copy, solid Black ink

Write

26a. Indicate the type(s) of transportation available for your

No

Are you willing to work in the office? (There are a
limited number of these jobs available.)

Yes

Speak Read

Section E – TRANSPORTATION

Most office positions involve working with computers.

Yes

Sat

a. Any hours
b. Morning

Section C – APPLICATION DATA

16.

No

Yes – Provide location (city and state) and position.

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

Yes

No

b.

Do you have a valid driver’s license?
Yes

No

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Section F – BACKGROUND INFORMATION
Answer questions 27 through 31 below. Read each statement carefully before responding.

Mark (X) one

When answering questions 27 through 29 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, and 5) any 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 27, 28, 29 and 30. 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]. If "YES," use Item 32 to provide the date, explanation of the violation, place of occurrence,
and the name and address of the police department or court involved.

27. During the past 10 years, have you been convicted, been imprisoned, been on probation or been on
parole? (Include felonies, firearms or explosives violations, misdemeanors, and all other offenses.) If "YES," use item 32
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

Yes

No

Yes

No

Yes

No

Yes

No

28. Have you been convicted by a military court-martial in the past 10 years? If no military service, answer "NO."
If "YES," use Item 32 to provide the date, explanation of the violation, place of occurrence, and the name and address
of the military authority or court involved.

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

30. 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 federal
agency? If "YES," use Item 32 to write for each job a) the name and address of the employer; b) the
approximate date you left the job, and c) an explanation of the problem and the reason for leaving.

31. 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 32 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.

32.

EXPLANATIONS OR ANSWERS TO QUESTIONS 1 THROUGH 31 – Attach additional listing if needed.

Section G – 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 birth date.
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 H – 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-170B (6-23-2011)

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