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pdfU.S. DEPARTMENT OF COMMERCE
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION
NOAA FORM 56-42
OMB Approved No. 0648-0047
APPLICATION FOR APPOINTMENT IN THE
NOAA COMMISSIONED OFFICER CORPS
Expires 07/31/2025
Furnishing this data is voluntary for use in determining your qualifications for appointment in the NOAA Commissioned Officer Corps.
INSTRUCTIONS - Type or print neatly in ink. Answer all questions completely by checking boxes and/or entering the information required. Enter "N/A" in any
question not applicable to you. Be certain to sign and date application in Section XII. If additional space is needed, answers may be continued in Section XI.
Detailed instructions for each question are provided on pages eight and nine of this form.
I. PERSONAL DATA
1. Last Name - First Name - Middle Name (explain variations from birth certificate in Section XI):
3. Mailing Address:
2. Date of Birth:
4. Physical Address (for receipt of overnight mail):
State:
City:
Zip:
City:
State:
Zip:
6. Primary e-mail address:
5. Daytime Phone (with area code):
Evening Phone (with area code):
Alternate e-mail address:
7. Birth Place (city/state or city/foreign country):
8. Country of Citizenship:
9. How was citizenship acquired?
10. If you are a male born after December 31, 1959, and are at least 18 years of age, civil service employment law (5 U.S.C. 3328) requires that you must
register with the Selective Service System, unless you meet certain exemptions.:
10a. Were you born a male after December 31, 1959?
No
Yes
10b. Have you registered with the Selective Service System?
No
Yes
10c. If "NO," describe your reason(s) in section XI
II. APPOINTMENT DATA
11. Date available for appointment: 12. Are you willing to accept an assignment in any geographic location?
13. Are you willing to relocate frequently (every two to three years)?
III. EDUCATIONAL INFORMATION (include graduate degree(s) or credits earned toward graduate degree)
14. Colleges or universities attended:
Degree(s) Awarded
Years Attended Graduation Date
or to be Awarded
Name of School
Location
Undergraduate
Yes
No
Yes
Major Field of Study
16. Courses (and credit hours) in progress or proposed prior to graduation:
15. GPA (4.0 scale):
No
Graduate
17. Speciality(ies) within major field:
18. Special educational honors or awards, scholarships, fellowships, membership in fraternities/sororities or student organizations, etc:
NOAA FORM 56-42
OMB Approved No. 0648-0047
Expires 07/31/2025
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IV. MILITARY BACKGROUND
19. Have you ever been rejected for enlistment in any component of the uniformed services? (If yes, furnish complete details in
Section XI.)
20. Have you ever been rejected for or disenrolled from any program leading to a commission in a uniformed service? Include military
service academies, federal and state maritime academies, all ROTC programs, Officer Candidate Training classes, platoon
leader's course, etc. (If yes, furnish complete details in Section XI.)
No
Yes
No
Yes
21. Do you have a service obligation to any other uniformed service? (If yes, furnish complete details in Section XI.)
No
Yes
22. Have you ever been discharged from any uniformed service under other than honorable conditions, separated for the good of the
Service, allowed to resign in lieu of involuntary separation, or demoted for cause? (If yes, furnish complete details in Section XI.)
No
Yes
23. Are you now or have you ever been a member of a foreign military service or been employed by a foreign government? (If yes,
furnish complete details Section XI.)
No
Yes
24. Are you now or have you ever been a conscientious objector? (If yes, furnish complete details in Section XI.)
No
Yes
25. Do you receive or have you applied for an annuity from the United States or District of Columbia government under any retirement
act or any pension or other compensation for military or naval service? (If yes, furnish complete details in Section XI.)
No
Yes
26. List all prior Uniformed Service Active Duty, Reserve Duty, Inactive Reserve Service or National Guard Service:
Type of Service
Name of Service
Type of Duty
Highest Rank or Rate Achieved
Dates of Service
From
To
V. INTERESTS AND HOBBIES NOT MENTIONED ELSEWHERE
VI. WORK EXPERIENCE (List present or most recent position first.)
27. May inquiry be made of your present or most recent employer regarding your character, qualifications and record of employment?
1
Dates of employment (month, day and year):
From:
Exact title of position:
To:
Salary or earnings & how paid (hourly, weekly, etc.): Name and title of immediate supervisor:
Starting:
Ending:
Name and address of company or organization:
Description of work:
No
Yes
Number & type of employees you supervise:
Reason for wanting to leave:
Type of business/organization:
NOAA FORM 56-42
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OMB Approved No. 0648-0047
Dates of employment (month, day and year):
From:
Expires 07/31/2025
Exact title of position:
Page 3
Number & type of employees you supervise:
To:
Salary or earnings & how paid (hourly, weekly, etc.): Name and title of immediate supervisor:
Type of business/organization:
Starting:
Ending:
Name and address of company or organization:
Reason for wanting to leave:
Description of work:
3
Dates of employment (month, day and year):
From:
Exact title of position:
Number & type of employees you supervise:
To:
Salary or earnings & how paid (hourly, weekly, etc.): Name and title of immediate supervisor:
Starting:
Ending:
Name and address of company or organization:
Description of work:
Reason for wanting to leave:
Type of business/organization:
NOAA FORM 56-42
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OMB Approved No. 0648-0047
Dates of employment (month, day and year):
From:
Expires 07/31/2025
Exact title of position:
Page 4
Number & type of employees you supervise:
To:
Salary or earnings & how paid (hourly, weekly, etc.): Name and title of immediate supervisor:
Type of business/organization:
Starting:
Ending:
Reason for wanting to leave:
Name and address of company or organization:
Description of work:
5
Dates of employment (month, day and year):
From:
Exact title of position:
Number & type of employees you supervise:
To:
Salary or earnings & how paid (hourly, weekly, etc.): Name and title of immediate supervisor:
Starting:
Ending:
Name and address of company or organization:
Description of work:
Reason for wanting to leave:
Type of business/organization:
NOAA FORM 56-42
OMB Approved No. 0648-0047
Expires 07/31/2025
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VII. ESSAY QUESTIONS
28. Why do you seek an appointment in the NOAA Commissioned Officer Corps?
29. What is your understanding of the duties of a NOAA Corps officer during an initial sea and/or aviation assignment? What would you anticipate being your
greatest challenges during this assignment?
30. "Honor, respect, commitment" are the core values of the NOAA Commissioned Officer Corps. What do these words mean to you?
NOAA FORM 56-42
OMB Approved No. 0648-0047
VIII. SPECIAL QUALIFICATIONS AND SKILLS
31. List professional licenses or certifications:
Type of License
State or Other Licensing Authority
Expires 07/31/2025
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Year of First Licence or
Certificate
Expiration Date of
Licence or Certificate
32. Special skills you possess and/or relevant operational experience (e.g. uncrewed systems, aviation, computer programming, diving, sonar, acoustics,
survey instruments, electronic equipment, small boats, fishing/trawling gear, oceanographic equipment, etc.):
33. Additional qualifications not previously addressed, such as relevant publications (do not submit unless requested), patents or inventions, public speaking
experience, membership in professional or scientific societies, professional honors and awards received, etc.:
IX. REFERENCES
List three to five persons who are not related to you and who have definite knowledge of your qualifications and fitness for an appointment in the NOAA
Commissioned Officer Corps. No more than one reference should be of a personal nature.
Full Name
Current Business or Home Address (number, street, city, state and zip code)
Business or Occupation
X. OTHER QUESTIONS
34. Have you ever been barred by the Office of Personnel Management from taking examinations or accepting a civil service
appointment? (If yes, give dates and reasons for such debarment in Section XI.)
No
Yes
35. During the past seven years, have you been convicted, imprisoned, on probation or parole or forfeited collateral, or are you now
under charges for any offense against the law? Do not include traffic fines for which you paid a fine of $300.00 or less, any
offense committed before your 18th birthday which was finally adjudicated in a juvenile court or under a youth offender law, any
conviction other record which has been expunged under Federal law, and any conviction set aside under the Youth Corrections
Act or similar State authority. (If yes, give details in Section XI for each incident including date, charge, place, law enforcing
authority or type of court and action taken.)
No
Yes
36. While in the military service, were you ever arrested for an offense which resulted in a trial by deck court or by summary, special,
or general court-martial? (If yes, give details in Section XI for each incident including date, charge, place, law enforcing authority
or type of court or court-martial and action taken.)
No
Yes
37. Have you ever been demoted, discharged (fired), asked or allowed to resign in lieu of separation for cause, or involuntarily placed
in a leave-without-pay status by either a government agency or private industry? (If yes, give complete details in Section XI.)
No
Yes
NOAA FORM 56-42
OMB Approved No. 0648-0047
Expires 07/31/2025
Page 7
38. Are you delinquent on any Federal debt? (Includes delinquencies arising from Federal taxes, loans, overpayment of benefits, and
other debts to the U.S. Government, plus defaults of Federally guaranteed or insured loans such as student and home mortgage
loans.) If "YES," use Section XI 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.
No
Yes
XI. ADDITIONAL INFORMATION AND/OR CONTINUATION OF ANSWERS TO PREVIOUS QUESTIONS
(Reference each question number and use additional sheets if necessary.)
XII. CERTIFICATION (Must be signed in ink.)
I certify that all statements in this application are true, complete and correct to the best of my knowledge and belief, and are made in good faith.
Signature:
Date:
NOAA FORM 56-42
OMB Approved No. 0648-0047
Expires 07/31/2025
Page 8
DETAILED INSTRUCTIONS FOR
APPLICATION FOR APPOINTMENT IN THE NOAA COMMISSIONED OFFICER CORPS
Section I: Personal Data
Item 1.
Enter your full given name, last name first.
Item 2.
Enter your date of birth.
Item 3.
Enter your present address
Item 4.
Enter a physical address where you can receive overnight mail. Overnight mail can not be delivered to a post
office box.
Item 5.
Enter phone numbers for contacting you both during the daytime and in the evening.
Item 6.
Enter primary and alternate e-mail addresses to which official correspondence may be sent.
Item 7.
Enter your place of birth (city and state or city and foreign country).
Item 8.
Enter the name(s) of the country(ies) of which you are recognized as an official citizen. Only United States
citizens can be appointed in the NOAA Commissioned Officer Corps. If selected as a Primary or Alternate
officer candidate, you will be required to furnish proof of United States citizenship prior to appointment.
Item 9.
Enter whether your citizenship was acquired by birth or by naturalization.
Applicants who are Naturalized Citizens must possess a Certificate of Naturalization to be considered for an
appointment in the NOAA Commissioned Officer Corps.
Applicants born in a country other than the United States, to parents who were United States Citizens, must
possess a Consular Report of Birth Abroad of a Citizen of the United States of America to be considered
for an appointment in the NOAA Commissioned Officer Corps. This document is referred to as a Consular
Report of Birth or Foreign Service Form 240.
Item 10.
Selective Service Registration - Indicate whether you are registered with the Selective Service System or are
not required to register. Males born after December 31, 1959, may be required to register with Selective
Service. Females are not required to register. To verify your registration or determine whether you must
register with Selective Service, visit the Selective Service website: www.sss.gov.
Section II: Appointment Data
Item 11.
Enter the earliest date you will be available for appointment or inter-service transfer, if selected.
Item 12.
Indicate whether you are willing to accept assignments in any location. Indicating “No” will greatly reduce
your potential for selection.
Item 13.
Indicate whether you are willing to relocate frequently. Indicating “No” will greatly reduce your potential
for selection.
Section III: Educational Information
Item 14.
Enter the full name of each college or university attended, institution location (city and state), degree(s),
years attended, graduation date, and major field of study. An official transcript is required from each college
or university you have attended, including any from which you have transferred credit. Unofficial or student
copies will not be accepted. Official transcripts may be submitted with your application or forwarded
directly to the NOAA Corps Recruiting Branch.
Item 15.
Enter the cumulative grade point average (GPA) for your undergraduate degree and for any graduate degree
completed or in progress.
Item 16.
List all courses and credit hours in progress that you will complete prior to the start of the Basic Officer
Training Class (BOTC) for which you are applying. You must have a conferred Bachelor's degree prior to
the start of BOTC. If your transcripts do not state that a Bachelor's degree has been awarded, they must be
accompanied by an official letter from the Registrar stating your courses in progress, major field of study,
and projected graduation date.
NOAA FORM 56-42
OMB Approved No. 0648-0047
Expires 07/31/2025
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Item 17.
List any specializations within your major field of study that you completed.
Item 18.
List educational honors, awards, scholarships, and/or fellowships you have received. List membership and
any leadership positions held in student organizations.
Section IV: Military Background
Items 19-25. Indicate “Yes” or “No” for each question. If not applicable, indicate “No”. Furnish complete details in
Section XI for any question to which you respond “Yes”.
Item 26.
Enter all information requested for prior service time, including Active Duty at any United States military
academy. Prior creditable service time, or a portion thereof, in any uniformed service of the United States
may be creditable toward pay, allowances, retirement, and/or promotion as an officer in the NOAA Corps.
Section V: Interests and Hobbies Not Mentioned Elsewhere
List any interests or hobbies not mentioned elsewhere that you would like to include.
Section VI: Work Experience
Item 27.
Indicate whether NOAA Corps may contact your present or most recent employer regarding your
application.
Provide a complete chronological list of your paid and/or volunteer work experience. List your present or
most recent position first. If you have more than five entries, you may enter additional information in
Section XI.
Section VII: Essay Questions
Items 28-30. Provide answers to three essay questions. Answers should highlight personal reasons for seeking an
appointment in the NOAA Corps, duties and challenges you expect during an initial sea assignment, and
your feelings about living the core values of a NOAA Corps Officer. Provide answers in the section below
each question or on a separate attached sheet. Answers should be no longer than one page total.
Section VIII: Special Qualifications and Skills
Item 31.
Item 32.
Item 33.
List all relevant professional licenses or certifications such as maritime or aviation licenses, professional
engineer license or FE/EIT certification, professional surveyor license, GIS certification, etc.
List any specialized skills or operational experience you have that would be beneficial in performing the
duties of a NOAA Corps officer.
List any other qualifications not previously mentioned that could be pertinent to this application, such as
foreign languages, patents, publications, public speaking experience, etc.
Section IX: References
List the names and contact information of three to five references that you will provide with NOAA Form
56-42D. References should be knowledgeable of your character, professional work or training, and
leadership potential. Your family members are not acceptable references. Professional references include
professors, employment supervisors, clergyman, etc.
Section X: Other Questions
Items 34-37. Answer “Yes” or “No” for each question. If not applicable, indicate “No”. Furnish complete details in
Section XI for any question to which you responded “Yes”.
Section XI: Additional Information and/or Continuation of Answers to Previous Questions
Use this space for any additional information and/or continuation of answers to previous questions. Be
certain to indicate the question number for each continuation.
Section XII: Certification
Read the certification statement then sign and date your application. Applications that have not been signed
will not be accepted, and the delay of submitting another application could cause you to miss the deadline.
U.S. DEPARTMENT OF COMMERCE
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION
NOAA FORM 56-42
OMB Control No. 0648-0047
Expires XX/XX/XXXX
APPLICATION FOR APPOINTMENT IN THE
NOAA COMMISSIONED OFFICER CORPS
Privacy Act Statement
Authority: The collection of this information is authorized under 33 U.S.C Chapter 43, National Oceanic & Atmospheric Administration Commissioned
Officer Corps.
Purpose: The information requested in this form is utilized to evaluate your qualifications for appointment in the NOAA Commissioned Officer Corps
(NOAA Corps).
Routine Use: Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a) to be shared among Department staff for
work related purposes. Disclosure of this information is also subject to all of the published routine uses as identified in the System of Records Notice
NOAA-1, Applicants for the NOAA Corps.
Disclosure: Furnishing this information is voluntary. However, failure to prove the requested data will preclude you from consideration for appointment in
the NOAA Corps.
Paperwork Reduction Act
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply
with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently valid
OMB Control Number. The approved OMB Control Number for this information collection is 0648-0047. Without this approval, we could not conduct this
information collection. Public reporting for this information collection is estimated to be approximately 2 hours for each application, 5 hours for each
interview, and 15 minutes for each reference, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the information collection. All responses to this information collection are voluntary. Send comments regarding
this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the NOAA Commissioned
Personnel Center, [email protected].
| File Type | application/pdf |
| File Modified | 2023-10-13 |
| File Created | 2023-10-11 |