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astronaut.doc

astronaut.doc

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astronaut.doc
astronaut.doc

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Published by: DarkPool on Nov 11, 2013
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ASTRONAUT CANDIDATE PROGRAM APPLICATION/UPDATE
New Application
 
Update to Application on File
Please complete all items on this form if this is a new application. If this is an update, complete only your name, address, and the information that has changed since your last update. You may attach additional sheets of paper if more space is needed.
1. LAST NAMEFIRST AND MIDDLE NAMES. SOCIAL SECURIT! NUM"ER
 
#. MAILING ADDRESS$. DATE OF "IRT%&. PLACE OF "IRT%
 
'. P%ONE NUM"ERS
 
(include area code)(Daytime)
 
(Evening)
 
(. MA! )E CONTACT !OUR CURRENT SUPER*ISOR+
YesNoContact me first
,. )OR- EPERIENCE
 Describe your paid and non-paid work eperience in the blocks below. You may attach a resume or C! or additional sheets of paper if more space is needed.a. "ob #itle
(if Federal or Military, include series and grade, or rank)
 
$rom%
(mm/yy)
#o% Present&alary%per%'ours per week%
 
(mployer)s name and address%&uper*isor)s name and phone number%
 
Describe your duties and accomplishments.
 
b. "ob #itle
(if Federal or Military, include series and grade, or rank)
 
$rom%
(mm/yy)
#o%
(mm/yy)
&alary%per%'ours per week%+eason for ea*ing
 
(mployer)s name and address%&uper*isor)s name and phone number%
 
Describe your duties and accomplishments.
 
"&C $orm / 0+e* 1ug 23 04& 5ord No* 63
 
,. )OR- EPERIENCE
 
(continued)
c. "ob #itle
 (if Federal or Military, include series and grade, or rank)
 
$rom%
(mm/yy)
#o%
(mm/yy)
&alary%per%'ours per week%+eason for ea*ing
 
(mployer)s name and address%&uper*isor)s name and phone number%
 
Describe your duties and accomplishments.
 
d. "ob #itle
(if Federal, include series and grade)
 
$rom%
(mm/yy)
#o%
(mm/yy)
&alary%per%'ours per week%+eason for ea*ing
 
(mployer)s name and address%&uper*isor)s name and phone number%
 
Describe your duties and accomplishments.
 
. EDUCATION
 
(Mark the highest level completed)
'&78(D1ssociate9achelor4asterDoctoral
10. COLLEGES OR UNI*ERSITIES ATTENDED
 
(Provide a copy of your final transcript for degrees received, do not send copies of diplomas)
Name, City, and &tateDates 1ttended#otal Credits (arned4a:or0s3#ype7Date Degree$rom#o&emester;uarter+ecei*ed
(mm/yy)
a.
 
b.
 
c.
 
d.
 
"&C $orm / 0+e* 1ug 23 04& 5ord No* 63Page <

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