The following questions are intended to obtain information related to all applicants' eligibility for employment, specific hiring preferences and authorities. Responses to these questions are mandatory when submitting your application.
DOCUMENTATION REQUIREMENTS: In any case where you are asserting an entitlement to a hiring preference or consideration under a special hiring authority you are required to submit proof of your claim with your initial application/resume package.
Current or Federal Employees: In cases where a SF-50, Notification of Personnel Action, is required you may obtain a copy of your SF-50 from your electronic Official Personnel Folder (eOPF) if you are a current Federal employee or if you are separated from federal government employment, you may obtain a copy of your SF-50 via Federal Records Center, National Archives and Records Administration, Civilian Personnel Records, 1411 Boulder Boulevard, Valmeyer, IL 62295 or visit the National Archives website (http://www.archives.gov/st-louis/civilian-personnel/faqs.html).
Veterans or Family Members of a Veteran: In cases where you are a Veteran or a family member of a Veteran and are claiming a related preference, you must submit a copy of your DD214, "Certificate of Release or Discharge from Active Duty," with your application/resume package. The DD214 must reflect the dates of service, character of discharge, and time lost, if any. This information is normally present on "Member copy 4" of the DD-214. For more information, review the VetGuide (http://www.opm.gov/policy-data-oversight/veterans-services/vet-guide/) or visit the U.S. Office of Personnel Management Government-wide Veterans Employment website (http://www.fedshirevets.gov/). You may request copies of your military personnel records online at the National Archives website (http://www.archives.gov/veterans/military-service-records/).
Active Duty Members of the Military: If you are currently on active duty and a DD214 has not been issued, you may be provided tentative preference if you provide a certificate of expected discharge or release from active duty indicating your expected separation date that has been issued within the last 120 days. However, if selected you will be required to provide a copy of your DD-214, prior to your entrance on duty. For more information, review the VetGuide (http://www.opm.gov/policy-data-oversight/veterans-services/vet-guide/) or visit the U.S. Office of Personnel Management Government-wide Veterans Employment website (http://www.fedshirevets.gov/).
1. Are you a United States Citizen or National?A. Yes
The Indian Health Service gives qualified American Indian/Alaska Natives preference when filling vacancies in accordance with the Indian Preference Act of 1934 (Title 25, USC, Section 472), with approved exceptions.
To be considered, a copy of BIA Form 4432, "Verification of Indian preference for employment in the Bureau of Indian Affairs and the Indian Health Service," which has been completed by authorized tribal or BIA Officials must be submitted with your application/resume package. For more information, review the IHS Indian Preference guidelines (http://www.ihs.gov/jobs/permanentDocs/indianpreference.pdf).
2. Are you claiming employment preference as an American Indian/Alaska Native?A. Yes, I am claiming Indian preference and have submitted a copy of BIA Form 4432 with my application/resume package.
Indian Health Service Scholarship Recipient
Recipients of the Indian Health Care Improvement Act (IHCIA) Health Profession Scholarship authorized under Public Law 94-437 who have completed the requirements of their approved health profession program and meet all eligibility criteria are entitled to a one time priority referral/selection to fulfill their obligation to provide public service. To receive consideration you must provide a copy of your transcripts.
If you are an IHCIA Health Profession Scholarship recipient who is pending completion of a health profession degree, the announcement for a specific position may allow you to be found tentatively eligible as an obligee if you complete your program with the established timeframe. To receive consideration for the position you must provide a copy of your transcripts and written proof from the education institution's registrar which provides the date for completing the professional program.
3. Are you an IHCIA Health Professions Scholarship recipient/obligee who is entitled to placement under Public Law 94-437, Section 104?A. Yes, I am an IHCIA Health Professions Scholarship obligee who has not previously utilized the one time priority placement opportunity at an Indian Health Service location; I have provided the appropriate proof of completion or pending completion of the program for which I received scholarship funding.
Current Federal Employees
Current Permanent Federal employees who attained status in the government may be eligible to be considered under a variety of competitive and non-competitive hiring authorities. To claim the status, you must submit a copy of your most recent SF-50.
4. Select the statement that best describes your claim as a current federal employee.A. I am a current federal employee of the Indian Health Service
Former Federal Civilian Employees Eligible for Reinstatement
Reinstatement eligibility applies to former Federal service employees who attained career status on a permanent, Excepted Service Examining Plan status appointment OR obtained career-conditional status. There is no time limit on the reinstatement eligibility of a preference eligible or a person who completed the service requirement for career tenure. There is a time limit for a non-preference eligible that has not completed the service requirement for career tenure within 3 years following the date of separation. See 5 CFR 315.401 for exceptions and additional information.
To receive reinstatement eligibility, submit a copy of your separation SF-50, "Notification of Personnel Action," that will identify your tenure upon separation.
5. Select the statement that best describes your claim as a former permanent federal civilian employee.
United States Public Health Service Commissioned Officers USPHS Commissioned Officer Candidates
All current United States Public Health Service (USPHS) Commissioned Officers and USPHS Commissioned Officer candidates who have successfully completed the professional boarding process and have obtained documentation from the Division of Commissioned Personnel and Readiness (DCCPR) stating you have been professionally boarded are eligible to compete for positions in the Indian Health Service advertised under the Merit Promotion Plan. NOTE: If a USPHS Commissioned Officer/Officer candidate applies for a position specifically advertised under any other authority such as, Delegated Examining, Direct Hire, or the Excepted Service Examining Plan, he/she will be referred as a civilian. If you accept the position as a civilian, you must retire from the U.S. Public Health Service (if eligible) or resign your commission as a Commissioned Corps Officer of the U.S. Public Health Service.
To prove eligibility as a USPHS Commissioned Officer, you must submit a copy of your official orders. To be considered as a USPHS Commissioned Officer candidate, you must submit sufficient proof of completion of professional boarding by DCCPR.
6. Select the statement that best describes your claim as a USPHS Commissioned Officer.
Political, Schedule C, Noncareer SES Appointee
In the last five years, based on the closing date of this announcement, have you been or are you currently an employee in the Executive Branch serving on a political, Schedule C, or Noncareer SES appointment? If yes, and you are selected through this vacancy announcement, you may be required to obtain approval by the Office of Personnel Management (OPM) prior to beginning employment.
7. A political appointee is an appointment made by the President without confirmation by the Senate (5 CFR 213.3102(c)) OR an Assistant position to a top-level Federal official if filled by a person designated by the President as a White House Fellow (5 CFR 213.3102(z)). A Noncareer SES appointee is approved by the White House and serves at the pleasure of the appointing official without time limitations. A Schedule C appointee occupies a position excepted from the competitive service by the President, or by the Director, OPM, because of the confidential or policy-determining nature of the position duties.
Career Transition Assistance Plan (CTAP)
CTAP eligibility generally applies to current federal employees displaced from the agency hiring for this position. If you have been separated under reduction-in-force (RIF) procedures or are in receipt of a Certificate of Expected Separation (CES) and were notified of your eligibility under CTAP confirm that you are in the area of consideration of the vacancy, your grade is equivalent to or below the grade level of the vacancy and your last performance rating of record is at least fully successful or the equivalent. You are required to submit supporting documentation to validate your claim of CTAP eligibility, including your latest SF-50, your last official performance evaluation and your RIF/CES notification letter.
8. Select the statement that best describes your claim as a CTAP eligible:
Interagency Career Transition Assistance Plan (ICTAP)
ICTAP eligibility generally applies to current or former federal employees displaced from an agency other than the one hiring for this position. If you were separated under RIF procedures by an agency other than the IHS, the HHS or an HHS OPDIV or are in receipt of a Certificate of Expected Separation (CES) and were notified of your eligibility under ICTAP confirm that you are in the commuting area of the vacancy, your grade is equivalent to or below the grade level of the vacancy, and your last performance rating of record is at least fully successful or the equivalent. You are required to submit supporting documentation to validate your claim of ICTAP eligibility, including your latest SF-50, your last official performance evaluation and your RIF/CES notification letter.
9. Select the statement that best describes your claim as an ICTAP eligible:
Veterans Employment Opportunity Act
Veterans Employment Opportunity Act (VEOA) eligibility applies to veterans who served 3 or more years of continuous active duty service in the military; OR are preference eligible; AND discharged under honorable conditions. If released shortly before completing a 3-year tour, you may meet this eligibility.
To receive VEOA eligibility, submit a member 4 copy of your DD214, "Certificate of Release or Discharge from Active Duty," with your application/resume package. If you are currently on active duty, provide a statement indicating your expected separation date.
For more information, review the VetGuide (http://www.opm.gov/policy-data-oversight/veterans-services/vet-guide/) or visit the U.S. Office of Personnel Management Government-wide Veterans Employment website (http://www.fedshirevets.gov/).
10. Select the statement that best describes your claim for VEOA eligibility.
Veterans Readjustment Act
Veterans Readjustment Act (VRA) preference applies to a:
• Disabled veteran;
• Veteran in receipt of a campaign badge for service during a war or in a campaign or expedition;
• Veteran in receipt of an Armed Forces Service Medal for participation in a military operation;
• Veteran separated from active duty within the past 3 years under honorable conditions
To receive preference as a VRA eligible you must submit copies of your DD214s, "Certificate of Release or Discharge from Active Duty," with your application/resume package.
11. Select the statement that best describes your claim for VRA preference.
Eligibility as a Disabled Veteran is afforded to veterans rated by the Department of Veterans Affairs (VA) as having a compensable service-connected disability of 30% or more; OR, a veteran who retired from active military service with a disability rating of 30% or more who was discharged under honorable conditions.
To receive preference as a disabled veteran, you must submit copies of DD214s, "Certificate of Release or Discharge from Active Duty," a SF-15, "Application for 10-Point Veteran Preference,", and the required VA Letter; OR if you are currently on active duty, a certificate of expected discharge or release from active duty dated within the last 120 days. Your DD214 must reflect the dates of service, character of discharge, and time lost.
12. Select the statement that best describes your claim as a Disabled Veteran with a Compensable Service-Connected Disability of 30% or More:A. Yes, I am claiming Disabled Veteran preference and have submitted the appropriate supporting documentation with my application/resume package.
Persons with Disabilities, Schedule A
Persons with Disabilities under Schedule A includes persons with an intellectual disability, a severe physical disability, or a psychiatric disability, eligible under 5 CFR 213.3102 (u). In order to receive consideration under the Schedule A authority, you must provide proof of disability with appropriate documentation including medical records from a licensed medical professional, a licensed vocational rehabilitation specialist or any federal or state agency that provides disability benefits. You may also be required to provide certification of job readiness. For more information, please visit USAJOBS Individuals with Disabilities (https://www.usajobs.gov/Help/working-in-government/unique-hiring-paths/individuals-with-disabilities/).
13. Select the statement that best describes your claim for Schedule A, Persons with Disabilities.
Miscellaneous Authorities Not Regulated By the Office of Personnel Management
Miscellaneous Authorities Not Regulated by the Office of Personnel Management applies to Postal Career Service Employees, Postal Service Commission Employees, Government Accounting Office Employees, United States Courts Employees, etc.
To receive eligibility, please submit a copy of your current SF-50, "Notification of Personnel Action," (or equivalent) that reflects your eligibility.
14. Select the statement that best describes your claim for Miscellaneous Authorities Not Regulated by the Office of Personnel Management.
Certain Family Members Eligible under Executive Order 12721
Certain Family Members Eligible under Executive Order 12721 applies to Appropriated Fund Federal employees AND is a family member of an appropriate sponsor (a Federal civilian employee, a Federal NAF employee, or a member of a uniformed service) while serving in an overseas area
To receive consideration under Executive Order 12721 submit proof of creditable service, performance appraisal and proof of return from the overseas tour of duty.
15. Select the statement that best describes your claim for eligibility under Executive Order 12721.A. I am claiming eligibility under Executive Order 12721 as a qualified family member and have submitted proof with my application/resume package.
Appointment of Certain Military Spouses and Family Members
Certain Military Spouses and Family Members of Veterans or Members of the Armed Forces may be eligible for hiring preferences or under special hiring authorities, including:
• Spouses of a member of the Armed Forces who has been issued orders for a permanent change of station(PCS), Executive Order 13473
• Spouses of a member of the Armed Forces who retired with a disability rating at the time of retirement of 100%;
• Spouses of a member of the Armed Forces who retired or separated from the Armed Forces and have a disability rating of 100% from the Department of Veterans Affairs;
• Un-remarried widow or widower of a member of the Armed Forces killed while in active duty status.
Under certain conditions
• Parents of a veteran who lost his or her life under honorable conditions while serving in the armed forces during a recognized period;
• Parent of a service-connected permanently and totally disabled veteran
To receive Military Spouse eligibility due to a permanent change of station you must submit a copy of Permanent Change of Station (PCS) orders issued within the last 2 years that lists you as authorized to accompany the military member to the new duty permanent station, the effective date of the PCS and documentation verifying marriage to the member of the armed forces (i.e., a marriage license or other legal documentation verifying marriage.) To receive preference as a spouse of a Veteran entitled to any of the remaining preferences you must submit verification of the member's 100% disability (VA Letter); and/or verification of the member's death while on active duty (DD-1300 and death certificate) and verification of the marriage to the service member (i.e., a marriage license or other legal documentation verifying marriage).
16. Select the statement that best describes your claim for military spouse or Family Member eligibility.
Foreign Service applies to people who served in the Foreign Service under an unlimited, career-type appointment AND immediately before separation from that appointment, have completed at least 1 year of continuous service without a break of a workday under one or more non-temporary Foreign Service appointments AND are within three (3) years of separation from a Foreign Service career-type appointment. The time limit does not apply to individuals entitled to veterans' preference or those who have completed three (3) years of substantially continuous service under one or more non-temporary Foreign Service appointments immediately before separation from an unlimited, career-type appointment. For additional information see 5 CFR 315.606.
To receive Foreign Service, submit a copy of proof of appointment.
17. Select the statement that best describes your claim for Foreign Service.A. Yes, I am claiming Foreign Service and have submitted proof of appointment with my application/resume package.
Determine which hiring plan you are eligible for and/or how you may be referred. If you are not sure, visit the IHS Jobs Board Which Plan Should I select (http://www.ihs.gov/Jobs/permanentDocs/WhichhplanshouldIselect.pdf).
18. Please indicate which of the following hiring plans you want to be considered under. You will only be considered for those that you indicate and are within reach for referral (Select all that apply)A. I would like to be considered for Merit Promotion Plan (MP), i.e., a permanent or separated permanent federal employee
Thank you for your interest in this Nurse Practitioner 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 Basic Requirements for a nurse position. Select the response that most closely and accurately describes your background which demonstrates how you meet the registration requirements. Select only one response and do not leave blank.
2. GS-09 From the descriptions below, select the response that best describes your experience which demonstrates your ability to perform the work of the Nurse Practitioner position at the GS-09. Select only one response and do not leave blank.A. I have completed both a professional nursing program and 1 year of specialized experience equivalent to at least the GS-07 grade level or pay band in the Federal service performing developmental nursing work that equipped me with the knowledge, skills and abilities to successfully perform the duties of this position. The experience is related to work of the position as described in the vacancy announcement. You will be required to submit your transcripts or nursing program documentation.
3. GS-11: From the descriptions below, select the response that best describes your experience as Nurse Practitioner which demonstrates your ability to perform the work of this position at the GS-11.A. Completion of all requirements for a doctoral degree (Ph.D. or equivalent) in nursing with a concentration in a field of nursing (e.g., teaching, a clinical specialty, research, administration, etc.) or in a closely related non-nursing field directly applicable to the requirements of this position.
4. GS-12: From the descriptions below, select the response that best describes your experience which demonstrates your ability to perform the work of this position at the GS-12.A. I have a degree or diploma from a professional nursing program approved by the legally designated State accrediting agency at the time the program was completed and one year of specialized experience equivalent to at least the GS-11 level as described in the vacancy announcement. You will be required to submit your transcripts or nursing program documentation.
5. GS-13: From the descriptions below, select the response that best describes your experience as Nurse Practitioner which demonstrates your ability to perform the work of this position at the GS-13.A. One year of specialized experience as Nurse Practitioner equivalent to at least the GS-12 level as described in the vacancy announcement.
INSTRUCTIONS: All applicants must meet both of the following Selective Placement Factors in order to be considered for this position. If you respond "Yes" to the Selective Placement Factors listed below, please submit the appropriate documentation and/or ensure this factor is supported in your resume.
6. From the descriptions below, select the one which best describes your education and meets the Basic Qualification Requirement for Nurse Practitioner, GS-0610-11/12/13.A. I have a current, active certification (in Family, Adult, Gerontology, Adult-Gerontology, Pediatric, Psychiatric-Mental Health, or Emergency) as a Nurse Practitioner issued by an appropriate certifying body, such as the American Academy of Nurse Practitioners (AANP) or through the American Nurses Credentialing Center (ANCC), or National Board of Pediatric Nurse Practitioners.
For each task below, select the appropriate response that best reflects your experience level. Please select only one response. Your resume and/or supporting documentation must support your response.A- I have not had education, training or experience in performing this task.
7. Conduct assessment on patients' needs in accordance with standards of care and the nursing process.
8. Provide emergency treatment to stabilize and transport patients.
9. Analyze data gained through interviews, review of health records, patients' response and/or consultation with physician and other staff member to assess patients' needs.
10. Diagnose and develop, implement, evaluate and revise an appropriate plan of care.
11. Provide nursing care based on interpretation of data obtained from assessment, interview, history review and lab values.
12. Coordinate with other professionals and agencies involved in providing services to patients and families.
13. Prescribe medications for a variety of symptoms and illnesses.
14. Provide preventative services to healthy individuals, including guidance in nutrition, illness prevention, accident prevention and growth and development.
15. Provide counseling and education related to prevention of disease, management of chronic medical conditions and maintenance of good physical and mental health.
16. Collaborate with physicians and other members of the medical team to provide quality patient care.
17. Develop and communicate treatment plan with respect to cultural background of the patient.
18. Aware of cultural issues that may impact the implementation of public health related programs for Native American populations.
19. Instruct patients and families in preventative, curative and/or rehabilitative measures.
20. Provide comprehensive nursing care to patients based on the physicians' medical care plan and the physical, mental and emotional needs of the patient.
21. Collect, organize and record data relevant to primary health assessments including detailed family and medical history, physical examination and laboratory test, etc.
22. Develop and implement nursing care plans.
23. Formulate action plans for problem areas identified through case management of internal Workers' Compensation cases.
24. Apply project planning and project management techniques and practices.
25. Monitor quality improvement activities.
26. Organize work, set priorities, determine goals and strategies, coordinate with other departments, monitor progress, and evaluate outcomes.
27. Assist employees with medical requirements and examinations.
28. Provide medical care, follow-up and consultant for employees exposed to infectious diseases.
29. Provide, document and track required employee testing and vaccinations.
30. Provide training/education about employee health requirements, common injuries and other employee health topics.
31. Develop recommendations for administrative problem resolution.
32. Evaluate and modify the services to improve and ensure quality customer service.
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.
33. 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.