Form BC-170 Census Jobs!

Attachment 1

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
The U.S. Census Bureau offers employment opportunities for a variety of positions and durations to support the collection of data
for the federal government. These positions may work varied schedules depending on assignments and job requirements. While
working, you will serve your country and make a difference in your community.
Program

Decennial
Census

Description

Types of Work

Duration of Work

The Census Bureau conducts a count of the entire population
every 10 years, in years ending in "0." Throughout the decade,
tests are also conducted in various locations in preparation for the
Decennial Census.

The Decennial Census
program offers the
following types of work:

The Decennial Census
program offers the
following duration of
work:

Large recruitment efforts begin one or two years prior to the
population count. Decennial positions tend to pay more than other
Census positions, but are short-term in nature. Positions most
often last several weeks.
The Census Bureau conducts surveys almost every day of the
year. Because of this, recruiting and hiring for these positions is
ongoing, and many employees have worked for the Census
Bureau for over 10 years.

Current
Survey

Special
Census

Data Collection
Outreach
Of ce

The Current Survey
program offers the
following types of work:

Data Collection
Current Survey positions vary in length but could extend several
Of ce
weeks, months, or years, depending on the survey work available.
Applicants who are selected for Current Survey positions will be
notified of the duration of the work assignment during the
interview.
Beginning approximately two years after Decennial Census
operations (i.e., in 2022 after the 2020 Census is conducted), the
Census Bureau may conduct Special Censuses in certain towns
and cities that contract with the Census Bureau to update their
population count.

The Special Census
program offers the
following types of work:
Data Collection
Of ce

Short-term

The Current Survey
program offers the
following duration of
work:
Long-term

The Special Census
program offers the
following duration of
work:
Short-term

TYPES OF WORK

DURATION OF WORK

Data Collection: The majority of available positions at the
Census Bureau involve data collection. Data collection involves
working from home and interacting with the public. These jobs
could involve the following tasks: knocking on doors to collect
personal information and verifying household address listings.
These jobs almost certainly require you to work nights,
weekends, and whenever respondents are available. Limited
data collection supervisory positions are also available for the
Decennial Census and Special Census programs.

Short-term: Most positions are short-term and generally last
several weeks.

Outreach: These positions are only available for the Decennial
Census program. These positions involve outreach to Census
partners and potential applicants for Census jobs. Outreach work
is conducted outside an office environment.
Of ce: For applicants who live close to one of the limited
number of Census Bureau offices, there are a few office
positions available. Office duties include a variety of clerical
support tasks such as file maintenance, data entry,
answering/making phone calls, word processing, shipping and
receiving, processing payroll and personnel actions, and other
administrative operations. Limited office supervisory positions
are also available for the Decennial Census and Special Census
programs.
CONFIDENTIALITY REQUIREMENT

Long-term: There are a limited number of long-term positions.
Long-term positions vary in length, but could extend several
weeks, months, or years, depending on the survey work
available. Applicants who are selected for long-term positions
will be notified of the duration during the interview.
TRAINING
If selected, you may be asked to attend a paid training session.
You may be asked to travel for training and will be reimbursed.
Certain positions may require you to complete automated
self-studies online and/or classroom training that may require
travel to another city on government per diem for several days,
including overnight travel. Other positions may require on-the-job
training, as well as refresher training sessions periodically.
PAY
Social Security deductions will be taken from your earnings.
Federal, state, and local income taxes, where applicable, also
will be deducted. You will be reimbursed for authorized out of
pocket expenses, telephone, and other travel costs, such as
parking fees, bus fares, etc., while on official business travel. If
hired, you will receive specific information about pay from a
Census representative.

If you are hired, the information you collect from the public
will be confidential and must NOT be disclosed to anyone
who has not been sworn in to protect Census Bureau
information.

CONTINUED on reverse side
BC-170

FORM
(6-5-2018)

Am I eligible for Census work?

The Application Process (Next Steps)

1. You must be a United States citizen.

The application process includes the following forms:

2. You must be 18 years old or older.
3. You must have a valid Social Security Number.
4. You must have a valid e-mail address. Any questions or
issues with your application will be communicated via this
email or by text message if provided. All job interviews
and job offers will be conducted via the phone numbers you
have provided.
5. You must answer assessment questions. For some positions,
the assessment questions may be available in Spanish;
however, an English Proficiency Test may also be required.
6. Male applicants born after December 31, 1959, must be
registered with the Selective Service System.
7. You must pass a Census Bureau performed criminal
background check and review of criminal records (including
fingerprinting) as part of the hiring process.

1. BC-170 – U.S. Census Employment Application
2. BC-171 – Additional Applicant Information
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 find the information listed
in the box below.

8. You may not engage in any partisan political activity while on duty.

Privacy Act and Burden Statement

9. Your current employment (including law and regulatory enforcement jobs) will be reviewed on a case-by-case basis for
compatibility with Census Bureau employment.

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.

10. Since not all people will be home during the day, you must be
available to work days, evenings, and/or weekends. Visits 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.
How do I complete the BC-170, U.S. Census
Employment Application?
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.
Below are a few explanatory notes for some of the items:
Section A – Applicant Pro le
Item 3. Enter your street address followed by your city, county,
state and ZIP code. Enter the State postal abbreviation
for the state in which you live, for example, MS for
Mississippi.
Item 6. Enter your e-mail address. E-mail is the primary way you
will receive information, should you be offered a position.
Item 7. Enter your contact number(s) in the appropriate fields,
and Mark (X) if Mobile.
Item 9a. Enter your Date of Birth. For example, enter July 6, 1952
as follows:
Month

Day

For more information, contact:

Year

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.
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.
The eight digit OMB number on the first page of this form
confirms our authority to collect this information.

FORM BC-170 (6-5-2018)

NOTE THE ACCURACY OF YOUR STATEMENTS WILL BE VERIFIED.

OMB No. XXXX-XXXX
U.S. DEPARTMENT OF COMMERCE

FORM BC-170
(6-5-2018)

U.S. CENSUS EMPLOYMENT APPLICATION

Economics and Statistics Administration

U.S. CENSUS BUREAU

Section A – APPLICANT PROFILE

1.

8.

Social Security Number

Sex Mark (X) in one box only.
Female

2.

9a.

Legal Name
Last Name

Suffix

First Name

MI

b.

Male

Date of birth
Month
Day

Year

Place of birth
City

3.

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

State or country

10a.

Are you a citizen or national of the United States?
Yes – SKIP to Item 11.
No – Provide country of citizenship

Address Continued

b.

Address Continued

Are you a lawful permanent resident of the United States?
Yes – Specify Alien Registration No./USCIS No.
No

City

11.

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

I certify that I am registered – Please enter your number below

ZIP Code

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) in one box only.

Selective Service Number

4.

Mailing address (if different from Item 3)
Address

I certify that I am not registered. Please provide explanation
in Section D or attach documentation of exemption.
Note: To find your Selective Service Number, please visit the Selective Service
website: https://www.sss.gov. If you would like to submit a paper copy of your
supporting documentation for selective service exemption, please contact the office
noted on the cover page of this form.

Address Continued

12.
a.

Address Continued
City

b.
County, Parish, Borough, or Municipio (Puerto Rico)

State

5.

ZIP Code

Nearest cross streets to your home address
Cross Street A
Cross Street B

6.

E-mail address

7a.Phone information
Area code
Primary

Number

Mark (X) Mark (X) in
if Mobile only one box
Phone
to receive
text messages

Secondary

Other

b. Do we have permission to text you on your mobile phone?*
Yes
No

Military Service
Do you claim veterans’ preference? Mark (X) in one box only.
No preference – SKIP to Item 13.
Yes
Veterans’ preference categories? Mark (X) in one box only.
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 a 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, 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)

A. Office/FSA

FOR OFFICE USE ONLY
B. FIPS State
C. FIPS County

D. Census Tract

E. BCU

*Standard data fees and text messaging rates may apply
based on your plan with your mobile phone carrier.

.
Page 1

F. Veteran’s proof
Verified &
attached

Military Service – Continued
Note: For more information and/or to determine if you are eligible for Veteran’s
Preference, please visit https://www.fedshirevets.gov/job/vetpref/index.aspx.
You must provide acceptable documentation of your preference or appointment
eligibility. Acceptable documentation includes:

19.

● A copy of your DD-214, "Certificate of Release or Discharge from Active Duty,"
which shows dates of service and discharge under honorable conditions.

Have you worked for the Federal government or military
and received a Voluntary Separation Incentive Payment
(VSIP) or "Buyout" within the past 5 years?
The majority of individuals who accept re-employment with the Federal
government within 5 years of receiving the VSIP/buyout amount must
repay the gross amount of the separation pay prior to reemployment.
I have NOT received a VSIP/Buyout from a prior Federal
appointment within the past 5 years

● A "certification" that is a written document from the Armed Forces that certifies the
service member is expected to be discharged or released from active duty service
in the Armed Forces under honorable conditions no later than 120 days after the
date the certification was signed.

I have received a VSIP/Buyout from a prior Federal
appointment within the past 5 years. I understand that I must
repay the full amount before I may be reappointed. If paid in
full, you must provide proof of payment.

● If you claim 10 point preference or sole survivorship, you must complete a
Standard Form 15 (SF-15), which is available online or at any Federal Job
Information Center. Submit a complete SF-15 and include the applicable
documentation required (listed on page 2 of the SF-15).

Indicate VSIP/buyout Year

● A letter from the Department of Veterans Affairs reflecting your level of disability
for preference eligibility.
Note: You may submit your application prior to providing the necessary
Veterans’ Preference supporting documentation. If you need to submit paper
copies of your documentation for Veterans’ Preference, please contact the
office noted on the cover page of this form. Please note that you will not
receive additional points until we verify your provided documentation.

Agency

20.

Section B – GOVERNMENT EMPLOYMENT HISTORY

13.

Yes – If yes, indicate relationship, current title, first/last name
and location

Have you ever worked for the Census Bureau?
Yes – Indicate most recent title and dates of employment.
No

Do any of your relatives currently work for the Census
Bureau? Include – Parents, spouse, children, grandparents,
siblings (include half), aunts, uncles, first cousins, nephews,
nieces, in-laws and step relatives.

No
Relationship

Title
Month

Month

Year

Year

First Name

TO

14.

Current Title

Last Name

Are you currently employed by a Federal government agency?
Yes – Indicate hire date, agency and title.
No

Month

Year

City

State

Agency

Hire date
If you need to add additional relatives continue in Section D.
Title

Section C – LANGUAGE SKILLS AND AVAILABILITY

15.

Are you currently employed by a state, local or tribal government
agency?

21.

Yes – Indicate current title and agency
No
Agency
Title

16.

Are you currently an elected of cial of any government agency?
Yes – Indicate current title and agency
No
Agency
Title

Some Census Bureau jobs require employees to conduct the Census
interview by reading and recording responses to questions in a language
other than English. The employee must 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
job-related training, but not language training.
Are you uent in any language where you can hold a
conversation, read and record responses, and respond to
questions in that language? If so, indicate the language(s) below
and mark (X) to all that apply.
Fluent
Language(s)
Dialect
Speak Read Write

Please include American Sign Language.
If you need to add additional languages continue in Section D.

17.

Are you currently employed by a law enforcement agency?
Yes – Indicate current title and agency
No
Title

18.

22.

Automobile

Agency

Check if 4-Wheel Drive
Airplane
Boat
ATV (All terrain vehicle)
Other – Describe –

Are you a retiree receiving a Federal annuity? If you are an
annuitant, your salary or annuity may be reduced upon employment. Social
Security payments are NOT considered a Federal annuity.

None

Yes – Indicate the agency and explain in Section D.

No

FORM BC-170 (6-5-2018)

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

If you have additional information continue in Section D.

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Section C – LANGUAGE SKILLS AND AVAILABILITY – Continued

23a. When are you available to work? Census field work will usually

require you to work evenings and weekends. Some positions will require
shift work. Hiring for some positions is based, in part, on your availability.
Mark (X) in All that apply

23b. Total hours per week you are willing
to work, up to and including 40.

Evenings
Weekends
Weekdays

Section D – ADDITIONAL INFORMATION (please list item number)

Section E – 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 ring you after you begin work. Also, you may be punished by ne 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 tness for federal employment by employers, schools, law enforcement agencies and other individuals
and organizations, to investigators, personnel staf ng 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-170 (6-5-2018)

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