Enter your Social Security Number in the space indicated. Providing your Social Security Number is voluntary, however we cannot process your application without it.
Please enter your e-mail address in the space provided. If you do not provide an e-mail address you may not receive a notice of your results.
Are you a citizen of the United States?
Enter the lowest grade (02) you will accept for this position.
The location code(s) for this position is (are):
Select the appropriate answer to the following questions based on your ability to perform the duties of this position. When answering the questionnaire, remember that your answers are subject to verification by investigation. You may be asked to provide specific examples or documentation of your knowledge or skills as proof to support your answers, or you may be required to verify a response by a practical demonstration of your claimed ability to perform a task. Please select only one letter for each item.
1. (Screen-Out) Reliability and Dependability: From the descriptions listed below, select the response that best describes your ability to perform reliably and dependably as a Housekeeping Aide, based on your past work and/or school performance. Please select only one answer.
In making your response, consider that this job includes such tasks as cleaning hospital patients' rooms, removing soiled linen and potentially contaminated items, cleaning and sanitizing restrooms, vacuuming and mopping floors, and emptying trashcans.
The following statements pertain to cleanliness, neatness, and concern for sanitation.
For each task in the following groups, choose the statement from the list below that best describes your experience and/or training. If applying by fax using OPM Form 1203-FX, darken the oval corresponding to that statement in Section 25. Please select only one letter for each item.A- I know little or nothing about this.
2. Using proper cleaning solutions and/or chemicals to successfully remove stains from a variety of surfaces (floors, carpet, tile, walls, etc.)
3. Applying appropriate cleaning solutions to various types of floors (linoleum, wood, or marble), walls, and ceilings to clean and maintain such surfaces.
4. Cleaning and sanitizing restrooms: urinals, commode, sink, mirror, etc.
5. Cleaning patients' rooms using sanitizing chemicals that will not compromise patients' health to disinfect surfaces.
6. Removing soiled linen from ward areas or clinics using the proper collection methods for handling possible contaminated items.
7. Keeping a stock of cleaning materials and equipment needed to do your work.
The following statements pertain to your ability to use housekeeping tools and equipment.
8. Operating powered equipment such as scrubbing machines, buffers, carpet cleaning machines and/or industrial vacuums.
9. Keeping equipment, cords, hoses, etc., clean and properly stored when not in use.
10. Using ladders and/or scaffolds to wash ceiling fixtures; washing or replacing venetian blinds, or room partitions.
11. Performing routine maintenance on cleaning equipment such as changing filters and brushes on vacuum cleaners and floor buffers.
12. Performing routine maintenance on cleaning equipment such as tightening nuts and bolts and/or greasing/oiling fittings and wheels.
The following statements pertain to your ability to handle weights and loads.
13. Pushing, pulling, lifting, carrying or moving cleaning equipment around for several hours or more at a time.
14. Standing/walking for several hours or more while cleaning and moving furniture.
15. Sweeping and mopping floors repetitively in high traffic areas such corridors, restrooms, stairways, entryways, cafeterias and other areas.
16. Taking care of a house doing work such as cooking, washing clothes, sweeping, mopping, washing dishes.
17. Emptying trashcans at various locations several times a day.
The following statements pertain to your ability to follow directions which vary from task to task.
18. Following sanitation and infection control procedures to prevent the spread of bacteria.
19. Selecting proper equipment to clean floors, carpet, drapes, and light fixtures.
20. Reading and following posted instructions through signs and pictures.
21. Following simple written instructions for completing non-routine cleaning tasks.
22. Following oral directions to perform simple tasks which may require several steps to complete.
The following statements pertain to your ability to work with dexterity and safety.
23. Adhering to safety policies and procedures when performing manual work.
24. Working quickly without accidents while at the same time being attentive to the quality of your work.
25. Recognizing typical health and safety hazards for yourself and other workers around you.
26. Working rapidly and accurately under the pressure of deadlines.
27. Using proper lifting techniques when lifting objects especially those that may be bulky and/or awkward.
Certification of Understanding
RESPONSE TO THIS STATEMENT IS MANDATORY. Please note, if you do not answer this question, it will result in not being considered for this position.
28. 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.A. Yes, I certify that the information provided in this questionnaire is true, correct and provided in good faith, and I understand the information provided above.
VETERANS PREFERENCE DOCUMENTATION REMINDER - You should submit proper documentation if you are claiming eligibility for veterans preference, which includes a copy of your DD-214 (member copy 4 or earlier version that shows character of service). Applicants claiming 10-Point preference should also submit an SF-15, Application for 10-Point Veterans Preference along with the required documentation listed on the form (such as verification of service-connected disability percentage).
Resume Reminder- Your resume must include the following information for each job listed:
Duties (be as detailed as possible)
Employment Dates (Example: June 2007 to April 2008)
Full-time or part-time status (include hours worked per week)
If you are a former or current Federal employee (military or civilian), please provide the series and grade or pay grade (rank) and the date of last promotion.