Exchange Employment Applications

Exchange Employment Applications

Drivers (ALL) - Sample ADN PA and Instructions

Exchange Employment Applications

OMB: 0702-0133

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Sample

Army & Air Force Exchange Service

Exchange Driver’s Supplemental Information

(Read Agency Disclosure Notice, Privacy Act Statement, and Instructions before completing form.)

OMB NO. 0702-

OMB approval expires

MMM DD, YYYY


AGENCY DISCLSOURE NOTICE


The public reporting burden for this collection of information is estimated to average 45 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 the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA 22350-3100 (0702-XXXX). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.


PLEASE DO NOT RETURN YOUR RESPONSE TO THE ABOVE ADDRESS.


Responses should be sent to the Exchange Human Resources Support Office at 3911 South Walton Walker Blvd., Dallas, TX 75236-1598 or your local Exchange Human Resource office.



PRIVACY ACT STATEMENT


AUTHORITY: Title 10 U.S.C. §3013, “Secretary of the Army”; Title 10 U.S.C. §8013, “Secretary of the Air Force”; Army Regulation 215-3, “Non-appropriated Funds Personnel Policy”; Army Regulation 215-8/AFI 34-211(I), “Army and Air Force Exchange Service Operations”; and Executive Order 9397 (SSN).


PRINCIPAL PURPOSES(S): This form collects information necessary to process motor vehicle operator applications for employment with the Army and Air Force Exchange Service within the continental United States of America.


ROUTINE USE(S): Records may be disclosed outside of DoD pursuant to Title 5 U.S.C. §552a(b)(3) regarding DoD “Blanket Routine Uses” published at http://dpcld.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx. This includes disclosure to Federal agencies, and state, local and territorial governments. Application data may be verified by LexisNexis Risk Solutions or other approved organization approved by the Exchange to complete an applicant’s background investigation.


DISCLOSURE: Voluntary, however, failure to provide all the requested information may result in the denial of your application for inadequate data.



INSTRUCTIONS


  1. Complete each area of the application in ink. Make sure the information is complete and accurate.


  1. Sign the form and present your CDL License number


  1. Present the form to a local Exchange Human Resource associate.




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