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): 825470
Announcement Number: IHS-HQ-13-825470-ESEP/MP
Enter the lowest grade level that you will accept for this position. The lowest grade for this position is 14.
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 Nurse Consultant (Patient Safety) 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.
1. In order to qualify for this position, you must meet the education and registration requirements for a nursing position. Select the response that most closely and accurately describes your background and which demonstrates how you meet the education requirements. Select only one response and do not leave blank.
2. Choose the one answer that best describes how you meet the qualification requirements of the Nurse Consultant (Patient Safety), GS-0610-14 described in the Qualifications Section of the Vacancy Announcement.A. I qualify for this position at the GS-14 level because I have one year of specialized experience equivalent to at least the GS-13 level in the Federal service obtained in either the private or public sector, performing the following types of tasks: analyzing and evaluating patient safety data; developing patient safety performance measures; preparing and presenting patient safety evaluations and reports; conducting or providing training on the aspects of safety for patients; developing and implementing policies, and procedures; and providing advice, guidance and expertise in a team environment.
3. I have led one or more programs beyond my immediate work unit.A. Yes
4. I have led one or more national programs, projects or initiatives.A. Yes
5. I have led one or more safety projects to fulfill hospital or clinic accreditation requirements.A. Yes
6. Have you had experience which included evaluating and analyzing a safety program or project using a variety of evaluation factors (such as workload, metrics or measures), preparing an analysis of the outcomes, and making recommendations for implementation and improvement in order to accomplish and achieve goals and objectives?
7. Have you had experience developing and managing databases to track progress in addressing and resolving safety or health problems?
8. Select the response that best describes your decision-making skills:
For each of the following task statements, select one response below (A-E) that best describes your experience level.
9. Analyze safety issues and identify, negotiate, and resolve problems that cut across organizational lines.
10. Develop the most cost effective and fiscally responsible method to conduct the activities of an organization and solve related problems including determining the allocation of human and financial resources and assure compliance with related legal requirements.
11. I have applied knowledge and expertise gained from working with patient safety initiatives or programs/projects.
12. I have demonstrated experience in program development, implementation, analysis, and evaluation of patient safety programs or projects.
13. Have you independently provided guidance, advice, consultation, and training to staff, other programs, divisions, and other agencies in the area of safety for patients?
14. Have you developed guidelines, standards, policies, and procedures for patient safety and health initiatives?
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.
15. 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.