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pdfU.S. DEPARTMENT OF COMMERCE
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION
NOAA FORM 56-42
OMB Control No. 0648-0047
APPLICATION FOR APPOINTMENT IN THE
NOAA COMMISSIONED OFFICER CORPS
Expires 02/29/2016
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 8-10 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):
10. Selective Service Registration (check one):
8. Country of Citizenship:
9. How was citizenship acquired?
I am registered with Selective Service.
I am not required to register with Selective Service.
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
Yes
No
Yes
Major Field of Study
16. Courses (and credit hours) in progress or proposed prior to graduation:
15. GPA (4.0 scale):
Undergraduate
No
Graduate
17. Credit hours earned in the following fields of study (indicate whether hours are based on a semester or quarter hour system):
Calculus
Semester Hours
Physics
Quarter Hours
Semester Hours
Quarter Hours
Total Science, Math and Engineering
Semester Hours
Quarter Hours
18. Speciality(ies) within major field:
19. Special educational honors or awards, scholarships, fellowships, membership in fraternities/sororities or student organizations, etc:
NOAA FORM 56-42
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IV. MILITARY BACKGROUND
20. Have you ever been rejected for enlistment in any component of the uniformed services? (If yes, furnish complete details in
Section XI.)
21. 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, etc. (If yes,
furnish complete details in Section XI.)
Page 2
No
Yes
No
Yes
22. Do you have a service obligation with any other uniformed service? (If yes, furnish complete details in Section XI.)
No
Yes
23. 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
24. 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
25. Are you now or have you ever been a conscientious objector? (If yes, furnish complete details in Section XI.)
No
Yes
26. 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
27. 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 Pay Grade Achieved
Dates of Service
From
To
V. INTERESTS AND HOBBIES NOT MENTIONED ELSEWHERE
VI. WORK EXPERIENCE (List present or most recent position first.)
28. 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:
No
Yes
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:
Is employment at a professional level?
Reason for wanting to leave:
Description of work:
No
Yes
NOAA FORM 56-42
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OMB Control No. 0648-0047
Dates of employment (month, day and year):
From:
Expires 02/29/2016
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:
Is employment at a professional level?
No
Yes
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:
Type of business/organization:
Starting:
Ending:
Name and address of company or organization:
Is employment at a professional level?
Reason for wanting to leave:
Description of work:
No
Yes
NOAA FORM 56-42
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OMB Control No. 0648-0047
Dates of employment (month, day and year):
From:
Expires 02/29/2016
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:
Name and address of company or organization:
Is employment at a professional level?
No
Yes
Reason for wanting to leave:
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:
Type of business/organization:
Starting:
Ending:
Name and address of company or organization:
Is employment at a professional level?
Reason for wanting to leave:
Description of work:
No
Yes
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Expires 02/29/2016
Page 5
VII. ESSAY QUESTIONS
29. Why are you seeking an appointment in the NOAA Commissioned Officer Corps?
30. What is your understanding of the duties of a NOAA Corps officer during his/her initial sea assignment, and what would you anticipate being your greatest
challenges during this assignment?
31. "Honor, Respect, Commitment" are the core values of the NOAA Commissioned Officer Corps. What do these words mean to you?
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VIII. SPECIAL QUALIFICATIONS AND SKILLS
32. List professional licenses or certifications:
Type of License
Licensing Authority
Expires 02/29/2016
Page 6
Year of First License or
Certificate
Expiration Date of
License or Certificate
33. Special skills you possess and/or relevant operational experience (computer programming, sonar operations, survey instruments, electronic equipment,
small boats, fishing/trawling gear, etc.):
34. 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 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. Family members are not acceptable references.
Full Name
Current Business or Home Address (number, street, city, state and zip code)
Business or Occupation
X. OTHER QUESTIONS
35. 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
36. 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 $150.00 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
37. While in the military service, were you ever arrested for an offense which resulted in a trial by summary, special, or general courtmartial? (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
38. 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
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Expires 02/29/2016
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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 blue 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 Control No. 0648-0047
Expires 02/29/2016
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.
NOAA FORM 56-42
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Expires 02/29/2016
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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.
Item 17.
Enter the total number of credit hours (semester hours and/or quarter hours) you completed in the following
three fields of study: (1) Calculus, (2) Physics, and (3) Total Science, Math and Engineering.
Item 18.
List any specializations within your major field of study that you completed.
Item 19.
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 20-26. 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 27.
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 28.
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 29-31. 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 32.
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.
Item 33.
List any specialized skills or operational experience you have that would be beneficial in performing the
duties of a NOAA Corps officer.
NOAA FORM 56-42
Item 34.
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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
Items 35-38. List the names and contact information of three to five references that you will provide with NOAA Form
56-42A. 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.
Before providing references with NOAA Form 56-42A, be certain to complete all fillable fields on page 1
and enter your name in the “Applicant's Name” field at the top of page 2. References may complete this
form electronically, but a hard copy with original signature must be forwarded directly to the NOAA Corps
Recruiting Branch.
Section X: Other Questions
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.
PRIVACY ACT ADVISORY STATEMENT
The information requested in this form is utilized to evaluate your qualifications for appointment in the NOAA
Commissioned Officer Corps (NOAA Corps). Furnishing this data is voluntary. Failure to provide the requested data will
preclude you from consideration for appointment in the NOAA Corps.
THE AUTHORITY FOR THE COLLECTION OF THE DATA IS:33 U.S.C.3001-3072
The public reporting burden for this collection of information is estimated to average 7 hours per response for each
applicant (including time for reviewing instructions, searching existing data sources, entering the data requested,
completing an interview and reviewing the collection of information) and 15 minutes per response for each reference. Send
comments regarding this burden estimate or any other suggestions for reducing this burden to:
Chief, Officer Recruiting Branch
NOAA Commissioned Personnel Center
8403 Colesville Road
Silver Spring, MD 20910
This information collection is a Privacy Act Systems of Records, COMMERCE/NOAA-1, Applicants for the NOAA Corps.
Responses to this information request are confidential under the Privacy Act of 1974 (5 USC 552a). Notwithstanding any
other provisions of the law, no person is required to respond to, nor shall any person be subjected to a penalty for failure to
comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection
of information displays a currently valid OMB Control Number.
| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |