Census Employment Inquiry

Attachment 5

Electronic BC-170 & BC-171 Mock-Ups
Note about this document:
This document contains mock-ups of what the Census Job Portal could look like when electronic BC-170 and the
BC-171 is programmed. It does not contain actual screen shots from a system that is being programmed. The
Portal will collect the information from the BC-170 and BC-171 electronically. The Portal could have a different
look and feel than the mock-ups. For example, items that use radio buttons in this mock-up may eventually be
programmed using check boxes, placement of text could change, the logo used could change, etc.. The questions
in the electronic version of the BC-170 and BC-171 will also be presented in a slightly different order than they are
presented on the paper version of the form. However, the same data will be collected on both forms.
Also note, some items in the mock-ups appear to be filled in. This is for illustration purposes only.
The pages 2 to 7 of this mock-up are not part of the BC-170 or BC-171. They are lead in screens where the
applicant will login and certify that they will use an electronic signature.

Screen #1 – Applicant Portal

As a valued member of the Census Team, you will be responsible for contributing to the fabric of our nation –
where every one counts.
For more information about 2020 Census jobs, please go to 2020census.gov/jobs. To apply for jobs within the
United States Census Bureau, please choose from the following:

Returning Applicants Login Here

*If you have already created a profile, you are considered a Returning User.
If you did not receive a verification e-mail, please click here

Screen #2 – Profile

Screen #3 – Returning User Login

Forgot your username? Click here

Screen #4 – Zip Code

Screen #5 – Applicant Portal
Status Bar

Census Help
FAQS

Not Yet Started

Apply

Screen #6 – Electronic Disclosure

Screen #6 – Electronic Disclosure
Applicants receive the following pop-up message when they click on “Privacy Act and Burden
Statement”

Solicitation of your personal information is authorized by Title 13 U.S.C., Chapter 1, Subchapter II,
Section 23a and c; Title 5 U.S.C., Part II, Chapter 13; Title 5 U.S.C., Part III, Chapter 33, Subchapter 1,
Section 1 and 20; and Executive Orders 9397, 10566.
The purpose of collecting this information is primarily to determine your qualifications for
employment and may also be used to identify you to other sources asked to comment on your
qualifications, e.g. educational institutions, former employers, and enforcement agencies, or to a
court during legal proceedings. Personal information collected includes your Social Security Number
(SSN), name, address, date of birth, telephone number, etc.
Disclosure of the information provided to us may be shared with other Census Bureau staff for the
work-related purposes identified in this statement as permitted under the Privacy Act of 1974 (5
U.S.C. Section 552a). Disclosure of this information is also subject to the published routine uses as
identified in the Privacy Act System of Record Notice OPM/GOVT-5, Recruiting, Examining, and
Placement Records.

Applicants will be directed to the
Census Bureau EEO Policy Page
Applicants when they click on “Click
here to learn more”will be directed to
the Census Bureau EEO Policy Page
https://www.census.gov/eeo/policy_s
tatements/

Furnishing this information is voluntary, but failure to provide any part or all of the data requested
will result in you 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 Reduction Project 0607-0139, Field Division Correspondence Liaison, U.S.
Census Bureau, 4600 Silver Hill Road, 5th Floor, Washington, DC 20233-1500. You may E-mail
comments to [email protected]; use "Paperwork
Reduction Project 0607-0139" as the subject.
OMB No. XXXX-XXXX confirms our authority to collect this information.
The U.S Census Bureau is an Equal Opportunity Employer. Click here to learn more

Screen #7 – Electronic Disclosure (Pop-up)

Applicants receive the following pop-up message when
they choose to opt out of the electronic Census
Application process:
Applying online is the fastest way to be considered for a
Census job. The manual process could delay your
application from being considered for several days to a
week or more. You can request a paper job application
by calling 1-855-562-2020. Choose the option for "other
calls". Enter your Zip code to be routed to the local office
in your area.

Note: Pop-up appears when the “I
choose to opt out of the electronic
Census Application and will use the
manual process instead” button is
selected

Screen #8 – Applicant Portal: Application Instructions
(U.S. Census Employment Application)?
Click on the icon for detailed instructions or information about completing the item.

To upload your document, please select the Browse button and select the appropriate file. The file name will appear in the field.
You will be asked to confirm/certify your entries on the job application once it is complete. In addition, you must also complete a set of assessment questions and submit
your answers before your application will be submitted.

All Applicants Will Be Required to Answer Assessment Questions. What are the Assessment Questions Like?
The assessment questions are designed to indicate your fit for a variety of Census jobs. By submitting one application and answering a basic set of assessment
questions, you may be considered for several positions. The assessment is physically accessible to people with disabilities. If you need a reasonable
accommodation for any part of the application and hiring process, please click the link below for further instructions.

Screen #9 – Applicant Portal: Application Instructions (Pop-up)
(U.S. Census Employment Application)?
Click on the icon for detailed instructions or information about completing the item.

To upload your document, please select the Browse button and select the appropriate file. The file name will appear in the field.
You will be asked to confirm/certify your entries on the job application once it is complete. In addition, you must also complete a set of assessment questions and submit
your answers before your application will be submitted.

All Applicants Will Be Required to Answer Assessment Questions. What are the Assessment Questions Like?
The assessment questions are designed to indicate your fit for a variety of Census jobs. By submitting one application and answering a basic set of assessment
Applicants receive the following pop-up message when
questions, you may be considered for several positions. The assessment is physically accessible to people with disabilities. If you need a reasonable
they click on the Instructions for Reasonable
accommodation for any part of the application and hiring process, please click the link below for further instructions.
Accommodations link:
Please call 1-855-562-2020 and choose the option for
other calls. Enter your Zip code to be connected to the
local office that supports your area. You may also use the
Federal Relay Service: (800) 877-8339 TTY/ASCII. For
more information go to www.gsa.gov /fedrelay

Note: Pop-up appears when user clicks “Instructions for Reasonable Accommodations”

Screen #10 – First Personal Information (Stateside)
Application
StatusStatus
Bar Bar

Applicants receive the following popup message when Social Security
Number field is changed after initial
application submission:
This change requires administrative
review. You will not be able to make
more changes until this update has
been reviewed. You will receive an
email once the review is finished.

Applicants receive the following popup message when the First Name or
Last Name field is changed after
initial application submission:
This change requires administrative
review. You will not be able to make
more changes until this update has
been reviewed. You will receive an
email once the review is finished.

Home Address
Please do NOT enter a PO Box or other non-physical address. Hiring may be partly based on
where you live. E-911 addresses, street addresses and RFD numbers are acceptable (include
apartment number, if any).
Address*
Address Continued
Address Continued
Zip Code*
City*
County, Parish, Borough, or Municipio (Puerto Rico)*
State*
Help Desk Number: 1-855-562-2020

Note: Only appears after
initial entry and if applicant
changes Social Security
Number

Screen #11 – First Personal Information (Puerto Rico)
Application
StatusStatus
Bar Bar

Home Address
Please
NOT
a or
POother
Boxnon-physical
or other non-physical
address.
may be partly based on
Please
dodo
NOT
enterenter
PO Box
addresses. E-911
addressesHiring
are acceptable.
where
you
addresses,
addresses and RFD numbers are acceptable (include
Hiring
may
be live.
partlyE-911
based on
where you street
live
Street
Addressnumber,
of RFT number
(include apartment number, if any)
apartment
if any).
House
Number and Street Name*
Address*

Name of Urb.

Address Continued
Address Continued

Name
of Area (ex. Barrio, Barriada, Parcel)
Zip Code*
Name
City*of Apartment Complex/Condominium/Public Housing
City
County, Parish, Borough, or Municipio (Puerto Rico)*

Municipio
State* (Puerto Rico) *

*
Help Desk Number: 1-855-562-2020

Only appears after initial
entry and if applicant
changes Social Security
Number

Screen #12 – First Personal Information (Continued)
Status Bar

Mailing Address
*

Address*
Address Continued
Address Continued
Zip Code*
City*

Mark if Mobile
Phone

Mark only one box to
receive text messages

County, Parish, Borough or Municipio (Puerto Rico)*
State*

Mark if Mobile Mark only one box to
Phone
receive text messages

Help Desk Number: 1-855-562-2020

Note: Drop-down
appears when
“MAILING
ADDRESS (if
different from
home)” box is
checked.

Screen #13 – First Personal Information (Continued) (Pop-up)
Applicants receive the following pop-up message
when Yes is selected:
The Application Portal provides documents,
instructions and statuses throughout the entire
process of Census employment, beginning with the
application and assessments. Users will receive an email and/or text message instructing them to log into
the Applicant Portal whenever there is a status
update or new documents to complete. Users MUST
complete documents in the Applicant Portal to move
forward in the employment process.

Mark if Mobile
Phone

Help Desk Number: 1-855-562-2020

Mark only one box to
receive text messages

Status Bar

Applicants receive the following popup message
applicant selects
Note:if the
Pop-up
Save & Exit:
appears when
Your application package is not
complete.
Please
return at a later
“Yes”
is selected
time to complete remaining
portion(s) of application.

Screen #14 – Second Personal Information
Status Bar

Note: Pop-up
appears when
“No” is selected
Applicants receive the following popup message if they select
No for this question:
You must be a United States citizen to be hired for a Census
job.
Note: To find your Selective Service Number, please visit the Selective Service website: https://www.sss.gov. If you are not registered, you may upload documentation to support an
exemption or provide an explanation. If you are unable to upload a document and would like to submit a paper copy of your supporting documentation, please call 1-855-562-2020 and
select the option for all other calls. Enter your zip code to be connected to a representative in your local office.

Attach Selective Service Supporting Documentation

Help Desk Number: 1-855-562-2020

Screen #15 – Veteran’s Preference
Status Bar

Applicants receive the following popup message when Veteran’s
Preference is changed after initial
application submission: This change
requires administrative review. You
will not be able to make more
changes until this update has been
reviewed. You will receive an email
once the review is finished.

o
o
o
o
o
o

5-point. Veteran is entitled to 5-point preference. (TP)
10-point/Disability. Veteran is entitled to 10-point preference due to a service-connected disability (includes recipient of the Purple
Heart who is not rated as having a compensable disability of 10 percent or more). (XP)
10-point/Compensable. A veteran who served at any time and who has a compensable service- connected disability rating of at
least 10 percent but less than 30 percent. (CP)
10-point/Other. Persons entitled to 10-point preference in this category: (1) Both the spouse and mother of veteran occupationally
disabled because of a service-connected disability; and (2) the widow/widower and mother of a deceased wartime veteran. (XP)
10-point/Compensable/30 Percent. Veteran is entitled to 10-point preference due to a compensable service-connected disability of
30 percent or more (CPS)
Sole Survivorship Preference Eligible. No points awarded. A service member who is released or discharged from the Armed Forces
after August 29, 2008, at the request of the member who is the only surviving child in a family in which the father or mother or one
or more siblings (1) served in the Armed Forces; (2) was killed, died as a result of wounds, accident, or disease, is in a captured or
missing in action status, or is permanently 100 percent disabled or hospitalized on a continuing basis (and is not employed gainfully
because of the disability or hospitalization); and (3) death, status, or disability did not result from the intentional misconduct or
willful neglect of the parent or sibling and was not incurred during a period of unauthorized absence. (SSP)

Attach Additional Supporting
Documentation

Help Desk Number: 1-855-562-2020

Note: You may submit your application prior to providing the necessary
Veteran’s preference supporting documentation. If you need to submit paper
copies of your documentation for Veteran's preference, please call 1-855-5622020 and select the option for all other calls. Enter your zip code to speak with a
representative in your local office. Please note that you will not receive additional
points until we verify your provided documentation.

Screen #16 – Government Employment History
History
*
Indicate most recent title and dates of employment.

Help Desk Number: 1-855-562-2020

Status Bar

Screen #17 – Government Employment History (Continued)
*

Status Bar

*
*

o I have an additional relative who currently works for the Census Bureau

Help Desk Number: 1-855-562-2020

Screen #18 – Language Skills & Transportation

Status Bar

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

Help Desk Number: 1-855-562-2020

Screen #19 – Availability

Status Bar

Mark ALL that apply. *

Help Desk Number: 1-855-562-2020

evenings and weekends.

Screen #20 – Electronic Signature
Status Bar

Screen #21 – Additional Applicant Information
Status Bar

This information is used to determine if our equal opportunity efforts are reaching all segments of the population, consistent with Federal equal employment opportunity
laws. Responses to these questions are voluntary. Your responses will not be shown to the selecting official or to anyone else who can affect your application. This form
will not be placed in your Personnel File nor will it be provided to your supervisors in your employing office should you be hired. The aggregate information collected
through this form will be kept private to the extent permitted by law. See the Privacy Act Statement below for more information.

Screen #21 – Additional Applicant Information
Applicants receive the following pop-up message when they click on the Privacy Policy link:

Status Bar

Privacy Act Statement: The collection of your personal information is authorized under 5 U.S.C. 7201, which provides
that the Office of Personnel Management shall implement a minority recruitment program, and by the Uniform Guidelines on
Employee Selection Procedures, 29 C.F.R. Part 1607.4, which requires collection of demographic data to determine if a
selection procedure has an unlawful disparate impact, and by Section 501 of the Rehabilitation Act of 1973, which requires
federal
agencies to efforts
prepareare
affirmative
plans for of
thethe
hiring
and advancement
of people
with disabilities.
This information is used to determine if our equal
opportunity
reachingaction
all segments
population,
consistent
with Federal
equal employment opportunity

laws. Responses to these questions are voluntary. Your responses will not be shown to the selecting official or to anyone else who can affect your application. This form
Personally identifiable information collected includes your education, race, ethnicity, disability, and medical information. Data relating
will not be placed in your Personnel File nor will it be provided to your supervisors in your employing office should you be hired. The aggregate information collected
to an individual applicant are not provided to selecting officials.
through this form will be kept private to the extent permitted by law. See the Privacy Act Statement below for more information.
The information provided to us may be shared with Census Bureau staff for the work-related purposes identified in this
statement as permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a). The aggregate, nonidentifiable information
summarizing all applicants for a position will be used by the Office of Personnel Management and by the Equal Employment
Opportunity Commission to determine if the executive branch of the Federal Government is effectively recruiting and selecting
individuals from all segments of the population and as per the Privacy Act System of Record Notice OPM/GOVT–7, Applicant Race,
Sex, National Origin, and Disability Status Records.
Providing this information is voluntary. No individual personnel selections are made based on this information. There will be no

.

impact on your application if you choose not to answer any of these questions.

Screen #21 – Additional Applicant Information
Status Bar

Applicants receive the following pop-up message when they click on the Paperwork Reduction Act link:
The Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et. seq,) requires us to inform you that this information is being
forefforts
planning
assessing
affirmative
program
initiatives.
This information is used to determine if our equal collected
opportunity
areand
reaching
all segments
of employment
the population,
consistent
with Federal equal employment opportunity
Response
to
this
request
is
voluntary.
An
agency
may
not
conduct
or
sponsor,
and
a person
is not
required toThis
respond
laws. Responses to these questions are voluntary. Your responses will not be shown to the selecting official or to anyone else who
can
affect your
application.
form
collection
information
unless
it displays
a currently
valid OMB
Control
The estimated
burden
of
will not be placed in your Personnel File nor will it to,
be aprovided
to of
your
supervisors
in your
employing
office should
you be
hired.Number.
The aggregate
information
collected
thislaw.
form
is the
five Privacy
(5) minutes,
including below
the time
reviewing
instructions. Direct comments regarding the
through this form will be kept private to the extentcompleting
permitted by
See
Act Statement
forfor
more
information.
burden estimate or any other aspect of this form to Paperwork Reduction Project 0607-0139, U.S. Census Bureau,
4600 Silver Hill Road, Field Division-Correspondence Liaison, 5th floor, Washington, DC 20233-1500 or you may e-mail
comments to [email protected]; use "Paperwork Reduction Project 0607-0139" as the subject and
to the Office of Management Budget, Office of Information and Regulatory Affairs, Washington, DC 20503.

Screen #22 – Additional Applicant Information (Continued)
Status Bar

How did you hear about Census Bureau job opportunities?

National or community organization- Specify _________________________

Screen #23 – Additional Applicant Information (Continued)
Status Bar

Mark all that apply.

Mark highest education level

Screen #24 – Additional Applicant Information (Continued)
Status Bar

Do you have any of the following? Mark all boxes that apply

I do not wish to identify my disability or serious health condition.
I do not have a disability or serious health condition.
I have a disability or serious health condition, but it is not listed above.

Screen #25 – Additional Applicant Information (Continued)
Status Bar

You indicated that you have a disability or a serious health condition. If you are willing, please select any of the conditions listed below that apply to you. As explained above,
your responses will not be shown to the panel rating the applications, to the selecting official, or to anyone else who can affect your application. All responses will remain
private to the extent permitted by law.

Note: This screen will only appear if the applicant
selects the following option on the previous screen
(#24): ‘Other disability or serious health condition:
for example, diabetes, cancer, cardiovascular disease,
anxiety disorder, or HIV infection; a learning
disability, a speech impairment, or a hearing
impairment.’

Help Desk Number: 1-855-562-2020