Please choose the answers below that best describe your employment and experience.
1. Are you a United States Citizen?
2. Are you a current VA Salt Lake City HCS employee?A. Yes
PLEASE NOTE: You must indicate the number of hours per
week worked for the experience listed in your resume (as indicated in the job
announcement). Failure to do so WILL result in your being rated not-qualified
for this position.
I acknowledge this requirement and have indicated the hours worked per week in my resume for all experience listed.
4. If you are a permanent employee of the facility in which this vacancy is offered, choose one of the statements below. Otherwise, choose F.A. I have not held the target grade of this vacancy, or a grade higher than the target grade, on a permanent basis AND I am currently in a career or career/conditional appointment.
5. Are you eligible for a VETERANS EMPLOYMENT OPPORTUNITY ACT (VEOA) APPOINTMENT? This means that you have Veteran Preference or you are a Veteran separated after substantially completing at least 3 years of continuous active duty service performed under honorable conditions (this means an honorable or general discharge).A. Yes
6. Are you a VETERANS RECRUITMENT ACT (VRA) APPOINTMENT? (You can only choose this answer for vacancies announced at or below the GS-11 grade level or an equivalent grade.) To be eligible, you must have been separated under honorable conditions (this means an honorable or general discharge). Also, you must be: a disabled Veteran; OR a Veteran who served on active duty in the Armed Forces during a war, or in a campaign or expedition for which a campaign badge has been authorized (you must have received the campaign badge or medal); OR a Veteran who, while serving on active duty in the Armed Forces, participated in a United States military operation for which you received an Armed Forces Service Medal; OR a recently separated Veteran (separated within the past three years).A. Yes
7. Are you a 30% OR MORE COMPENSABLY DISABLED VETERAN? To be eligible, you must have retired from active military service with a service-connected disability rating of 30% or more, OR have a rating by the Department of Veterans Affairs showing a compensable service-connected disability of 30% or more.A. Yes
8. Are you eligible for some other NONCOMPETITIVE APPOINTMENT? This includes appointment based on an interchange agreement, severe disability, eligibility of some military spouses, or similar authorities. Please visit http://www.opm.gov/hr_practitioners/lawsregulations/appointingauthorities/index.asp to see information about interchange agreements and other noncompetitive appointments. MILITARY SPOUSES: please visit http://www.fedshirevets.gov/job/shams/index.aspx for more information about appointment eligibility.A. Yes
If you chose A, please tell us the type of appointment for which you are eligible (for example, military spouse eligible).
9. VERIFICATION STATEMENT: Your rating is subject to verification based on the résumé, narratives and other relevant documents you submit, and through verification of references as appropriate. Deliberate attempts to falsify information are grounds for non-selection and for termination. In addition, falsifying information on your application can result in your being barred from federal employment. Please choose A to certify that your answers are accurate and complete.A. I certify that my answers are accurate and complete.
INSTRUCTIONS: The assessment part of the questionnaire includes questions about basic requirements, minimum qualifications, and KSAs (knowledge, skills and abilities) related to this position. NOTE: If you are faxing your application and filling out the 1203-FX form, you may notice that the numbering restarts here with number one. When entering your responses on the 1203-FX form, please continue to enter your responses on the next available number within this section of the form.
NOTICE: Your responses to the following questionnaire WILL be verified against all uploaded documents for this vacancy announcement. Failure to provide supporting information and/or documentation may result in a lower score or even being rated as ineligible for the position.
1. Are you a citizen of the United States?
The following questions pertain to your degree in Psychology and psychology internship training program. You must have a doctoral degree in psychology from a graduate program in psychology accredited by the American Psychological Association (APA), AND have successfully completed a professional psychology internship training program that has been accredited by APA.
2. Do you possess a doctoral degree in Psychology from an accredited college or university whose curriculum in Psychology is approved (at the time of your graduation) by the American Psychological Association (APA)? (UNOFFICIAL TRANSCRIPTS REQUIRED)
Provide month/year of graduation and name of college or university.
3. Have you successfully completed a professional psychology internship training program that has been accredited by APA?
Where did you complete your professional psychology internship training and when?
The following questions pertain to your licensure and/or certification. Note: The Psychologist must hold a full, current, and unrestricted license to practice psychology at the doctoral level in a State, Territory, Commonwealth of the United States, or the District of Columbia
4. Do you hold a full, current, and unrestricted license to practice psychology at the doctoral level in a State, Territory, Commonwealth of the United States, or the District of Columbia?
Provide your license number, state licensed, and expiration date.
In accordance with 38 U.S.C. 7402(d), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. You must be proficient in basic written and spoken English in order to perform the duties of this position.
5. Are you proficient in basic written and spoken English?
6. For the GS-13: Do you have at least one additional year of experience as a Psychologist equivalent to the next lower grade level (GS-12) with the following demonstrated knowledge, skills and abilities to perform at the level of the GS-12 Psychologist?
1) Knowledge of, and ability to apply, advanced professional psychological theories and techniques to the full range of patient populations.
2) Ability to provide professional advice and consultation in areas related to professional psychology and behavioral health.
3) Knowledge of clinical research literature
4) For supervisory assignments:
a) Ability to provide supervision in areas related to behavioral health and social services provision in order to accomplish the organizational goals and objectives.
b) Ability to provide fair, principled and decisive leadership for a work environment that promotes shared accountability.
Certification of Understanding - Select the appropriate answer to the statement below. Failure to provide an answer will result in your not being considered for this position.
7. My responses to the above supplemental questionnaire for this vacancy announcement are supported and included in my uploaded documents (e.g. application forms, resume and/or transcripts).