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.
Enter the lowest grade level that you will accept for this position. The lowest grade for this position is 12.
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
Section 231 of the Crime Control Act of 1990, Public Law 101-647, requires that employment applications for individuals seeking employment in a position involved with the provision to children under the age of 18 of “child care services,” as defined in 42 U.S.C. 13041(a)(2), contain a question asking whether the individual has ever been arrested for or charged with a crime involving a child and for the disposition of the arrest or charge. Under 42 U.S.C. 13041(a)(2), the term "child care services" means child protective services (including the investigation of child abuse and neglect reports), social services, health and mental health care, child (day) care, education (whether or not directly involved in teaching), foster care, residential care, recreational or rehabilitative programs, and detention, correctional, or treatment services. Individuals hired for such positions must undergo a criminal history background check. Section 408 of the Indian Child Protection and Family Violence Prevention Act, Public Law 101-630, contains a related requirement for positions in the Department of Health and Human Services that involve regular contact with or control over Indian children. The agency must ensure that persons hired for these positions have not been found guilty of or pleaded nolo contendere or guilty to certain crimes. The law requires that the agency conduct an investigation of the character of each individual who is being considered for employment in such a position and prescribe in regulations the “minimum standards of character” that must be met in order for an individual to fill such a position. The regulations specify that “[t]he minimum standards of character shall be considered met only after the individual has been the subject of a satisfactory background investigation,” which includes a criminal history background check. 42 C.F.R. § 136.406.
2. Have you ever been arrested for or charged with a crime involving a child?A. Yes
3. Have you ever been found guilty of, or entered a plea of nolo contendere (no contest) or guilty to, any felonious or misdemeanor offense under Federal, State or tribal law involving crimes of violence; sexual assault, molestation, exploitation, contact or prostitution; or crimes against persons; or offenses committed against children?A. Yes
If “YES”, provide the date, explanation of the violation, disposition of the arrest or charge, place of occurrence, and the name and address of the police department or court involved.
The following section is used to determine your eligibility for appointment under the Delegated Examining or Direct Hire Authority in the Indian Health Service. Please respond "Yes" or "No" to the following statements. Do not leave any section blank.
The following section is used to determine your eligibility for appointment under the Delegated Examining or Direct Hire Authority 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 eligibility as indicated below. Failure to provide documents will render you not eligible for the consideration. See instructions undert the "How to Apply" tab for submitting documentation.A- Yes.
4. 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.)
5. 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).
6. Are you a former competitive service employee who was separated by a Reduction in Force (RIF) to be considered eligible as a Career Transition Assistance Plan (CTAP) or an Interagency Career Transition Program (ICTAP) applicant or placed on the agencies Reemployment Priority List (RPL) based on a RIF or separated because of work related injuries? (You must submit the appropriate supporting documentation).
Thank you for your interest in this Nurse Midwife 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. I have a Baccalaureate degree or higher education in a professional nursing program which was approved by the legally designated State accrediting agency.A. Yes
2. I have an active, current unrestricted registration as a professional nurse in a State, District of Columbia, the Commonwealth of Puerto Rice, or a territory of the United States. (Must submit copy of current registration with application)A. Yes
3. I have an active, current unrestricted registration as a nurse midwife completed by an organized program of study and clinical experience recognized by the American College of Nurse Midwives. (Must submit copy of current registration with application)A. Yes
4. I have one year of experience providing nurse midwife services which consists of providing women's health care with emphasis on the reproductive cycle including management of the intra-partum period; providing health care for normal newborns; educating counseling and advising patients on all aspects of the reproductive cycle and related psychosocial issues.A. Yes
Respond Yes or No to the following statements, indicating those areas that you have experience providing and assessing patient care needs.A- Yes
5. I have experience performing vaginal examinations and deliveries.
6. I have experience performing fetal monitoring to assess fetal well-being.
7. I have experience performing neonatal resuscitation.
8. I have experience in family planning including oral contraceptives, IUDs, and insertion of birth control implants.
9. I am able to collect, assess and interpret accurately patients clinical and laboratory data.
10. I am capable of observing, examining, and monitoring well women, maternity (OB/GYN), diabetic patients and new born health care issues.
11. I am able to provide an appropriate plan of care for patients.
12. I have experience in scheduling appointments, consults and referrals based on interpretation of data obtained from patient assessment.
13. I have experience providing in-service training to patients related to women's health issues.
14. I have experience training other departmental personnel in implementing new skills related to women's health.
15. I have experience providing advice, lectures, presentations, etc. to multidisciplinary professionals regarding OB/GYN issues.
16. I have participated in Quality Risk Management Activities and/or Performance Improvement projects related to Women's Health Care.
17. I have experience engaging family members as active participants in their after-care.
18. I have experience working with people from different cultural orientations.
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.
19. 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.