[Federal Register Volume 60, Number 163 (Wednesday, August 23, 1995)]
[Notices]
[Pages 43822-43825]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-20947]



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OFFICE OF PERSONNEL MANAGEMENT


Notice of Request for Approval of Application Form Submitted to 
the Office of Management and Budget

AGENCY: President's Commission on White House Fellowships.

ACTION: Notice.

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SUMMARY: In accordance with the Paperwork Reduction Act of 1980 (44 
U.S. Code, chapter 35), this notice announces a proposed revision of 
the White House Fellowship Application which has been submitted to the 
Office of Management and Budget for approval. This form is completed by 
persons wishing to apply for a Fellowship. The information is used by 
the Commission to evaluate an applicant's qualifications.
    Approximately 1,000 applications are completed annually, requiring 
an estimated five hours each, for a total annual burden of 5,000 hours. 
Response is required to be considered for a Fellowship.
    A copy of the proposal is appended to this Notice.

DATES: Comments on this proposal should be received within 10 calendar 
days from the date of this publication. OMB has been requested to take 
action within 10 calendar days.

ADDRESS: Send or deliver comments to Joseph Lackey, Desk Officer, 
Office of Information and Regulatory Affairs, Office of Management and 
Budget, New Executive Office Building NW., Room 10235, Washington, DC 
20503, U.S. Office of Personnel Management.
Lorraine A. Green,
Deputy Director, Office of Personnel Management.

White House Fellowship Application

Instructions

    Type all responses. Answer all questions fully and accurately, and 
sign and date the application in the space provided in Question 4.
    Questions 1-4 should be answered on the first two pages of the 
application. (These pages may be recreated on a word processor, 
however, the format must remain exactly the same.)
    Be sure to carefully follow the directions for Question 5: it is 
your receipt.
    The remaining questions should be answered on separate sheets of 
plain white 8\1/2\'' x 11'' paper. Each sheet should include your name, 
social security number, and the question number in the upper right 
corner.
    You may include additional items with your application, such as 
publications featuring or authored by you, books you have written, or 
music you have recorded. Use your best judgment. Generally, unpublished 
academic papers and copies of award certificates are not helpful.
    Applications must be postmarked by December 1. It is the 
responsibility of the applicant to ensure a package mailed on December 
1 is postmarked with that date. Applications mailed from overseas 
should be sent by air mail as early as possible. Mail applications to: 
The President's Commission on White House Fellowships, 712 Jackson 
Place, NW., Washington, DC 20503. While applications may be downloaded 
electronically from the Internet, they may not be filed by e-mail. Only 
hard-copy paper applications with original signatures will be accepted. 
Applicants will be notified by mail that their application has been 
received.
    Only U.S. citizens are eligible to apply. Civilian employees of the 
federal government are not eligible. The Commission cannot consider 
applications from ineligible applicants, nor grant exemptions from 
these requirements.

[[Page 43823]]

    The federal government is an equal opportunity employer. Hiring is 
based on qualifications and performance regardless of race, color, 
creed, religion, sex, age, national origin, sexual orientation or 
disability.

Application Checklist

First 2 pages of the application (Questions 1-4)
Cards requested in Question 5
Lists and essays (Questions 6-15)
Sealed recommendations (Question 16)

Part I

1. Personal Data
Name (last, first, middle)
Mr.    Mrs.    Ms.    Other
Birthdate (mo/day/yr)
Other names used
Are you a US citizen: Yes    No
Social Security Number
Occupation: (Profession, student, self-employed, retired, etc.)
Current employer's name and address:
Your title, rank, or status:
Home address:
Mailing address where you wish to receive Commission mailings, if 
different from above:
Home phone:
Work phone:
Fax number:
E-mail address:

    Have you ever worked for or are you now working for the federal 
government, or are you being paid by federal funds? (Include active 
duty military service.) If so, please explain below and give inclusive 
dates.

Yes    No

Explanation:
2. Personal Declarations
    Please answer the following questions and explain on a separate 
sheet of paper details and resolution of any question answered ``yes.''
    Have you ever been discharged from the Armed Forces under other 
than honorable conditions?

Yes    No

    Have you ever been convicted of a criminal offense?

Yes    No

    Have you ever been charged with a felony?

Yes    No

    Have you ever been charged with a violation of any firearms or 
explosives laws?

Yes    No

    Have you ever failed to meet a court-ordered child support payment?

Yes    No

    Are you delinquent on any federal debt?

Yes    No

    Have you ever been suspended, disciplined, or barred from any 
occupation or practice by any regulatory agency, professional 
association or organization because of your conduct?

Yes    No
3. References
    In the space below, list the names and contact information for the 
individuals whose personal evaluations accompany this application (see 
Question 14). You may submit a minimum of 3 and a maximum of 5 
recommendations for consideration.

Name-------------------------------------------------------------------

Address----------------------------------------------------------------

Phone------------------------------------------------------------------
4. Certification
    I certify that all of the statements made in this application are 
true, complete, and correct to the best of my knowledge and belief, and 
are made in good faith. I know and understand that any or all items 
contained herein may be reviewed by representatives of the Commission, 
including former White House Fellows, and are subject to investigation 
or verification and I consent to the full release of all information 
concerning my capacity and fitness by employers, educational 
institutions (who are authorized to release my academic records), law 
enforcement agencies, and other individuals and agencies to duly 
accredited investigators of the federal government or the Commission 
for that purpose.

Signature (in ink)

Date-------------------------------------------------------------------
5. Required Cards
    The following must be included with your application or it will not 
be considered:
    A typed 3'' x 5'' index card that lists on one side your name, 
address, home and work phone numbers, date of birth, and date of our 
application; and
    A self-addressed, stamped postcard. This card will be mailed to you 
as a receipt upon its arrival in the Commission office.
Part II

Instructions

    The following questions should be answered on separate sheets of 
paper. Type your name, social security number and question number in 
the upper right corner of each page. Do not return or reproduce the 
questions with your application; submit only your answers.
6. Career Summary
    It is helpful for the Commissioners evaluating your application to 
see ``at a glance'' the development of education and career patterns. 
Therefore, on a separate sheet of paper under the heading, ``Career 
Summary,'' please provide a chronological listing of all positions you 
have held, beginning with the most recent. Include dates, employers 
and/or schools attended. Account for all periods of unemployment. 
Please limit your response to a maximum of one page; details can be 
furnished in response to later questions.

Example:

6/92-present--Sr. Vice President, Acme Pictures
9/90-9/92--Director of Sales, Acme Pictures
6/90-9/90--Unemployed-job search
8/89-6/90--MBA student, Enormous State University
8/86-6/89--College student, Small State College
7. Educational Background
    On a separate sheet of paper, type the heading ``Educational 
Background'' and include the following. Generally, answers to this 
question should not exceed one page.
    A. Under the heading, ``Schools Attended,'' list all schools 
attended, including high school. List the degree or diploma earned, the 
name of each school, its location, dates attended and class rank.

Example:

    MBA, Enormous State University, Anytown, USA, 8/89-8/90, top 
quarter.
    BS, engineering, Small State College, Anothertown, USA, 8/86-8/89, 
school does not rank students.
    B. If appropriate, under the heading, ``Tests and Exams,'' list all 
tests and examinations required of you in order to quality for the 
practice of any occupation or profession. For each test or examination, 
list each time you took the test, the administrating agency, the state 
or jurisdiction and year of such exam. For each test, also indicate 
whether or not you passed or failed.
    C. Under the heading, ``Activities,'' list all of the major 
extracurricular activities in which you participated. Briefly explain 
each one and list the level of your participation, including any 
offices held, the length of your membership and the level of your 
participation. Also list any major awards or recognitions received. 

[[Page 43824]]

8. Work Experience
    On a separate sheet of paper, type the heading ``Work Experience'' 
and list information about your employment history. Work back from your 
current position and account for all periods of employment and 
unemployment. Do not substitute a resume. You may use as many sheets as 
required. Use the following as a guide:

Dates of employment
Exact job title
Employer
Employer's address and phone number
Nature of the business
Salary history
Number of workers you supervised

    9. For each entry you may, at your option, provide a brief 
narrative description of the work you performed, not to exceed 200 
words for your current position and 100 words for all previous 
positions. Describe any outstanding contributions made by you and list 
any citations, awards, or unusual promotions.

Example:

6/92-present
Sr. Vice President
Acme Pictures, Inc.
1234 C Street, Anytown, USA 54321. (202) 555-1212
Videotape distributor
Paid $70,000/yr on 6/92; currently earn $80,000/year
Supervise 19 employees
10. Professional and Occupational Activities
    On a separate sheet of paper, type of the heading, ``Professional 
and Occupational Activities'' and list the major business and 
professional activities in which you have participated during the past 
ten years. Use the following guide:

Name of organization
City and state
Purpose or objective of the organization
Size of organization
Your level of participation
Dates of your participation
Awards or recognition you received for participation

Example:

The Generic Business Get-Together Group
Washington, DC
Professional advancement of business; lobbies Congress
2,000 nationwide
Co-founder; current vice president
8/93-present
No awards
11. Most Significant Achievement-Professional
    On a separate sheet of paper, type the heading, ``Professional 
Achievement'' and then describe in 200 words or fewer what you consider 
to be your most significant contribution to your professional field. If 
you exceed 200 words your application will be disqualified.
12. Most Significant Achievement-Community Service
    On a separate sheet of paper, type the heading, ``Community Service 
Achievement'' and then describe in 200 words or fewer what you consider 
to be your most significant voluntary contribution to your community. 
If you exceed 200 words your application will be disqualified.
13. Memorandum for the President
    On a separate sheet of paper, type the heading, ``Memorandum for 
the President'' and write a memorandum of not more than 500 words for 
the President, making a specific policy proposal. Explain why you think 
it is important, what issues it raises, and why you think the President 
should support it. If you exceed 500 words your application will be 
disqualified.
14. Lifetime Goals
    On a separate sheet of paper, type the heading ``Lifetime Goals'' 
and describe in 300 words or fewer your life's ambition, what you hope 
to accomplish or achieve in your lifetime, and what position you hope 
to attain. If you exceed 300 words your application will be 
disqualified.
15. Why I Want to be a White House Fellow
    On a separate sheet of paper, type the heading, ``Why I Want to be 
a White House Fellow'' and describe in 300 words or fewer why you want 
to be a White House Fellow, what you consider to be your major 
strengths and qualifications for the program, and what benefits you 
feel are likely to result from your participation. If you exceed 300 
words your application will be disqualified.
16. References
    Please reproduce the enclosed personal evaluation letter and give 
it to a minimum of 3 and a maximum of 5 people who know you well. 
Recommenders should have a direct knowledge of your qualifications and 
character. At least one person listed should have professional 
competence in your field, at least one should have knowledge of your 
major community or civic activities, at least one should have knowledge 
of your business or professional accomplishments, and at least one 
should be your present supervisor, if applicable. Each reference should 
seal the letter of recommendation in an envelope, sign his or her name 
across the seal, and return the form to you. These references must be 
included in your application. Your application cannot be considered 
without these references.
White House Fellowship Application Candidate Evaluation

To: Individuals Completing an Evaluation
Subject: (Applicant's name)
From: The President's Commission on White House Fellowships

    Thank you for taking the time to write a recommendation for the 
White House Fellowship applicant named above. Your candid and specific 
responses to the questions below will help the President's Commission 
select the next class of Fellows, 11 to 19 individuals from across the 
nation who will come to Washington to work for one year as paid, full-
time special assistants to Cabinet officers and senior White House 
officials.
    Please answer the following questions (on your office letterhead, 
if appropriate) and include your daytime telephone number. Please sign 
your evaluation, place it in a sealed envelope, write your signature 
over the seal, and return it to the applicant. The applicant must 
submit your evaluation as part of his or her application.

1. How long and in what connection have you known the applicant?
2. What are the applicant's major strengths? Please relate an occasion 
in which these strengths were demonstrated.
3. What are the applicant's major weaknesses?
4. What impact has the applicant had on his/her professional field?
5. What impact has he/she had in the community, outside the applicant's 
professional realm?
6. What has the candidate done that you consider creative?
7. How would you rate this candidate's writing ability?
8. How would you rate this candidate's intellectual ability?
9. How would you rate this candidate's public speaking ability?
10. How would you rate this candidate's personal integrity?
11. How would your rate this candidate's consensus-building, 
negotiating and leadership skills?

[[Page 43825]]

12. If you were a Cabinet Secretary, would you hire this person to be a 
key member of your staff?
13. What would you expect this candidate to be doing in 15 to 20 years?

Privacy Act and Paperwork Reduction Act Statements

    Pursuant to the Freedom of Information Act (5 U.S.C. 552, as 
amended) and the Privacy Act (5 U.S.C. 552a), the President's 
Commission on White House Fellowships operates its competitive 
application process and collects personal information for its use in 
evaluating applicants under authority of Executive Order 11183, as 
amended. Submission of the information is voluntary; however, 
failure to furnish all the requested information may result in delay 
or elimination of consideration for a Fellowship. All files, 
records, and other material submitted by or in behalf of any 
applicant, or collected or obtained with regard to an applicant, are 
used by those persons associated with the Commission for the purpose 
of screening and evaluating applications. The information may also 
be disclosed to a congressional office in response to an inquiry 
from that office made at the request of that individual. Executive 
Order 9397 provides for the collection of Social Security Numbers to 
identify individual records. Furnishing your Social Security Number 
is voluntary; however, failure to do so may delay the processing of 
your application.
    This request is in accordance with the clearance requirements of 
the Paperwork Reduction Act (44 U.S.C. 3507). The information is 
being collected in order to evaluate your qualifications for a 
Fellowship. Your response is required to make this determination. 
Public reporting burden for this collection of information is 
estimated to average five (5) hours per response, including time for 
reviewing instructions, gathering the requested personal 
evaluations, and completing the application. Please send comments 
regarding this burden estimate or any other aspect of this 
collection of information, including suggestions for reducing the 
burden, to the President's Commission on White House Fellowships, 
Washington, DC 20415.

Records Retention

    The application forms of persons selected as White House Fellows 
may be circulated to appropriate Executive Branch officials incident 
to placing Fellows in assignments for the Fellowship year and 
subsequently may be retained, along with other applicant file 
materials, by the Commission in its permanent files on persons who 
are selected as White House Fellows. These permanent records are 
accessible to the individuals concerned.
    Sixty days after a letter has been mailed to an applicant 
advising that he or she has been eliminated from the competition, 
all materials in the applicant's file will be destroyed and this 
procedure will be repeated after each stage of the selection 
process.
    The Commission cannot assume responsibility for the return of 
applications or supporting documents. Applicants are therefore 
advised to retain copies of their application forms and not to 
submit irreplaceable documents or other materials with applications.
[FR Doc. 95-20947 Filed 8-22-95; 8:45 am]
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