References for NOAA Corps Applicants

U.S. DEPARTMENT OF COMMERCE
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION
NOAA FORM 56-42A
OMB Control No. 0648-0047

NOAA COMMISSIONED OFFICER CORPS

Expires XX/XX/XXXX

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, Chief.NOAACorps.Recruiting@noaa.gov.

APPLICANT'S NAME:
I. PERSONAL DATA - Please answer the following questions:
1. What is your relationship to the applicant?
2. How long have you known the applicant?
II. EMPLOYMENT DATA - If you are familiar with the applicant's employment history, please answer the following questions to the best of your knowledge
and comment where applicable.
1. What is the highest position applicant held in professional employment?
2. Why did applicant leave job?
3. Has applicant ever been discharged for inefficiency, neglect of duty or moral unfitness? (If yes, please comment below.)

No

Yes

III. GENERAL RATING - Please rate applicant on the factors stated below and check best trait in the column to the right:
Factors to be considered:

Very Good

Good

Acceptable

Poor

Best Trait

1. Reliability
2. Ability to work harmoniously with others
3. Emotional stability
4. Integrity
5. Ability to adjust to reassignments and relocations
6. Self-confidence
7. Initiative
8. Leadership
9. Trust involving security of the United States
10. Ability to process information and react quickly
IV. OVERALL RATING - Using a scale of 1 to 10, rate the applicant using "1" for a rating of very poor and "10" for a rating of exceptionally
outstanding. For example, a rating of "5" might be for a person with an average scholastic record, half of the above factors marked "Good" and
half marked "Very Good".
V. REMARKS:

Signature: (required)

Printed Name:
Title:

NOAA FORM 56-42A

OMB Control No. 0648-0047

Date
Expires XX/XX/XXXX

OVERALL