Enter your Social Security Number in the space indicated. Your Social Security Number is requested under the authority of Executive Order 9397 to uniquely identify your records from those of other applicants who may have the same name. As allowed by law or Presidential directive, your Social Security Number is used to seek information about you from employers, schools, banks and others who may know you. Providing your Social Security Number is voluntary, however we can not process your application without it.
Vacancy Identification Number (VIN): 753901
Announcement Number: IHS-HQ-12-753901-DH
Enter the lowest grade level that you will accept for this position. The lowest grade for this position is 15.
Select/enter at least one occupational specialty. The specialty code for this position is:
Select/enter at least one geographic location in which you are interested and will accept employment. The location code for this position is:
1. Are you a United States Citizen or National, who is at least 16 years old?A. Yes
The following section is used to determine your eligibility for appointment under the Merit Promotion or Excepted Service Examining Plan in the Indian Health Service. Please respond "Yes" or "No" to the following statements. Do not leave any section blank. NOTE: You must submit the required documentation to verify your eligibility as indicated below. Failure to provide the required documents will render you not eligible for consideration. See instructions under the "How to Apply" tab for submitting documentation.
The following section is used to determine your eligibility for appointment under the Merit Promotion or Excepted Service Examining Plan in the Indian Health Service. Please respond "Yes" or "No" to the following statements. Do not leave any section blank.A- Yes.
2. Are you a current, permanent (non-temporary) civilian employee on a competitive service appointment in a Federal agency or a former civilian Federal employee who achieved career status in the competitive service; or an interchange agreement eligible; or a VEOA eligible; or a former civilian Federal employee who served on a career-conditional appointment and was separated less than three years ago without achieving career status in the competitive service? (You must submit supporting documentation).
3. Are you eligible for Indian preference as defined by the Department of the Interior (DOI) and as evidenced by appropriate Bureau of Indian Affairs (BIA) authorized certification? (You must submit a properly completed and signed copy of the Bureau of Indian Affairs (BIA) Form BIA-4432, "Verification of Indian Preference for Employment in the Bureau of Indian Affairs and the Indian Health Service," for employees claiming Indian preference.)
4. Are you an Indian Health Service scholarship recipient who has completed the necessary requirements for an approved health profession degree in accordance with your academic institution and under the Indian Health Care Improvement Act (IHCIA)? (You will receive highest priority placement consideration for available vacancies within the IHS).
5. Have you held a permanent position in the competitive service at the same grade level with the same or higher promotion potential as this position; or be an Interagency Career Transition Program (ICTAP) applicant; or be eligible for a special appointment authority such as a Schedule A for the severely disabled? (You must submit supporting documentation).
6. Are you interested in performing the duties of this position within the United States Public Health Service Commissioned Corps? (You must submit sufficient information to permit this office to determine whether you meet the qualification requirements, including any selective placement factor).
INSTRUCTIONS: The following section is used to determine your Method of Consideration/Referral.
7. Please indicate which of the following plans you want to be considered under: you will only be considered for those that you indicate and are within reach for referral. Do not leave this section blank.
NOTE: You must also submit the required documentation to verify your eligibility as indicated in the vacancy announcement. Failure to provide the required documents will render you not eligible for consideration.
Thank you for your interest in this Supervisory Medical Officer position with the Indian Health Service.
We will evaluate your resume and your responses to this Assessment Questionnaire to determine if you are among the best qualified for this position. Your responses are subject to verification. Please review your responses for accuracy before you submit this questionnaire.
SECTION I. MINIMUM QUALIFICATIONS AND FACTORS.
1. BASIC REQUIREMENT-Degree In order to qualify for this position you must meet the following educational requirements. Select the response that most closely and accurately describes your background and which demonstrates how you meet the education requirements.A. I have a Doctor of Medicine or Doctor of Osteopathy from a school in the United States or Canada approved by a recognized accrediting body in the year of the applicant's graduation.
2. BASIC REQUIREMENT-GRADUATE TRAINING Subsequent to obtaining a Doctor of Medicine or Doctor of Osteopathy degree, a candidate must have had at least 1 year of supervised experience providing direct service in a clinical setting. Select the response that most accurately describes your graduate training background.A. I have completed, at minimum, a 1-year internship program which involved a broadly based clinical practice in which physicians acquire experience in treating a variety of medical problems under supervision (e.g., internal medicine, surgery, general practice, obstetrics-gynecology, and pediatrics). Such programs are in hospitals or other institutions accredited for internship training by a recognized body of the American Osteopathic Association (AOA).
3. BASIC REQUIREMENT-LICENSURE This physician position provides direct patient care; as such, all eligible candidates must meet the licensure requirement.A. I have a permanent, full and unrestricted license to practice medicine in a State, District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.
From the descriptions below, select the response that best demonstrates your ability to perform the work of this position at the GS-15. Select only one response and do not leave blank.
4. Examples of demonstrated specialized experience includes; 3 years of residency AND 2 year's additional specialized experience working in diabetes clinic or diabetes program providing comprehensive clinical management for people living with diabetes; work directly involved with clinical and scientific consultation on diabetes programs and prevention initiatives (e.g., developing national policies and clinical practice guidelines). Additional experience should demonstrate collaborations and partnerships with other federal and non-federal diabetes organizations, developing health professional and patient education materials related to diabetes treatment and prevention, and development of organizational work plans and performance evaluations while overseeing a subordinate staff.A. I have one year of specialized experience equivalent to at least the GS-14 level in the Federal service obtained in either the private or public sector.
5. I have an applied understanding of the mission, legal and political authorities, and administrative systems of:A. I have not had education, training or experience in performing this task.
6. I have applied my understanding of the mission and administrative systems of an organization to:A. I have not had education, training or experience in performing this task.
7. Have you used formal academic training to interpret or evaluate technical information related to the job?A. Yes
8. Have others relied on your clinical advice, for which you were held accountable?A. Yes
9. Have you advised others who have a variety of educational backgrounds and levels of experience?A. Yes
10. Does your medical education and on-the-job experience equip you to provide expert policy and technical advice on diabetes-specific clinical and preventive program objectives?A. Yes
11. Does your academic medical training enable you to advise other medical experts, patients, family members and those who do not possess medical expertise?A. Yes
12. I have made sound, well-informed and objective decisions; perceived the impact and implications of those decisions; committed to action, even in uncertain situations; to accomplish organizational goals; and caused change.A. Yes
13. Select the response that best describes your decision-making skills:A. I have not had education, training or experience in performing this task.
14. I have developed and maintained effective relationships with others, including individuals who are hostile or distressed;A. Yes
15. I have extensive experience relating well to people from varied backgrounds; and have been sensitive to cultural diversity, race, gender, disabilities and other individual differences.
16. I have demonstrated skill in oral and written communications, gathering and conveying information, making oral presentations, and preparing reports, correspondence, and other written materials at the Agency level.
17. I have experience in making oral presentations at national meetings and Congressional hearings, oral briefings and reports to Congress, Tribal leaders, and other senior leadership and to a wide variety of audiences including medical professionals and technical experts at all levels of the IHS and HHS.
SECTION II. CERTIFICATION OF INFORMATION ACCURACY
As previously explained, your responses in this Assessment Questionnaire are subject to evaluation and verification. Later steps in the selection process are specifically designed to verify your responses. Deliberate attempts to falsify information will be grounds for disqualifying you or for dismissing you from employment following acceptance. Please take this opportunity to review your responses to ensure their accuracy.
Certification of Information Accuracy
If you fail to answer this question, you will be disqualified from consideration for this position.
18. I certify that, to the best of my knowledge and belief, all of the information included in this questionnaire is true, correct, and provided in good faith. I understand that if I make an intentional false statement, or commit deception or fraud in this application and its supporting materials, or in any document or interview associated with the examination process, I may be fined or imprisoned (18 U.S.C. 1001); my eligibilities may be cancelled, I may be denied an appointment, or I may be removed and debarred from Federal service (5 C.F.R. part 731). I understand that any information I give may be investigated. I understand that responding "No" to this item will result in my not being considered for this position.