Fillable MILITARY SPOUSE PPP SELF-CERTIFICATION CHECKLIST IMPORTANT: This form (Defense Manpower Data Center)

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MILITARY SPOUSE PPP SELF-CERTIFICATION CHECKLIST IMPORTANT: This form (Defense Manpower Data Center)

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November 2019
1
MILITARY SPOUSE PPP SELF-CERTIFICATION CHECKLIST
IMPORTANT: This form must be submitted with your application each time you
apply to a Department of Defense (DoD) position on USAJOBS in order to receive
Military Spouse Preference.
Applicant’s Name:
Military Sponsor’s Name:
Date of Marriage to Military Sponsor:
Military Sponsor’s
Last or Current Duty Station:
Military Sponsor’s New (or Future Sequential) Duty Station:
Date of relocation or anticipated relocation to Sponsor’s New Duty Station:
INSTRUCTIONS - Read items 1-12 and click on each “Choose an Item.” Choose the words from the drop-
down menu that best describes your status as a military spouse. Completion of
each item is verification that you have read and understand that the information you provide is truthful and can
be used to help to verify your eligibility as a military spouse preference applicant. A new self-certification
checklist must be submitted with each application and must
be dated within 30 days of the announcement opening date. Upon completion of this form, we recommend
saving a copy to your USAJOBS account for future use.
1. I
a US Citizen.
2. an active duty military member of the U.S. Armed Forces (including the
U.S. Coast Guard and full-time National Guard or Reserves) and my sponsor has been
serving on active duty for more than 180 consecutive days.
3. My sponsor’s Permanent Change of Station (PCS) orders in conjunction with
retirement or separation from active duty.
4. that preference only applies to positions within the commuting area of my
sponsor’s current permanent duty station.
5. that loss of spousal status due to divorce, death of my sponsor, or my
sponsor’s retirement or separation from active duty will result in terminating my eligibility
for spouse preference.
6 . that the acceptance or declination of a temporary position does not impact
my priority placement status. “Temporary” positions include:
a Positions filled by temporary or term appointment, including Non-
Appropriated Fund (NAF) time-limited appointments, regardless of duration or work schedule;
Choose an item
Choose an item
Choose an item
Choose an item
Choose an item
Choose an item
November 2019
2
b Positions filled by permanent appointment with intermittent or seasonal work
schedules; and
c NAF positions with a “flexible” work schedule, or any NAF position for
which the employment category is identified as “flexible.”
7. that I am only eligible for preference for ONE job offer of a permanent
position. A “permanent position” is defined as a Federal appropriated or non-appropriated
position which has a fixed full-time or part-time work schedule.
8. that accepting or declining a permanent position will result in terminating
my eligibility for military spouse preference at my current location.
9. received a job offer for a
permanent position within the commuting area
of my military sponsor’s current permanent duty station.
10. currently occupying a permanent appropriated or non-appropriated
position at the current duty station.
11. on
a telework agreement with my current federal job that allows me to
work for them on a permanent basis after relocating to my military sponsor’s current duty
station.
12. had on-the-job performance or conduct problems within the last 12
months. Provide any details you wish to share.
Certification Statement: I,
, certify that I have read and
understand the information contained in this self-certification checklist and my
responses are accurate and truthful.
Date:
Documents that may be required to be submitted with each application: (Note: DoD
agencies may require some, or all. Please refer to the job announcement to ensure all required
documentation is submitted with your application. It is highly recommended that you save all
these documents to your USAJOBS account in order to facilitate applying to multiple positions.
Military Spouses without prior Federal work experience
o Narrative resume
o PCS orders
o Marriage certificate or license
o Signed self-certification checklist
o Veteran’s preference documentation (e.g., DD-214, VA letter, Statement of
Service), if applicable
o Transcripts, if applicable
Choose an item
Choose an item
Choose an item
Choose an item
November 2019
3
Military Spouses with prior Federal work experience
o Narrative resume
o PCS orders
o Marriage certificate or license
o SF-50s (e.g., LWOP, highest grade held, overseas appointments, etc.)
o Documentation of performance rating of record (dated within the last 12
months), if applicable
o Signed self-certification checklist
o Veterans preference documentation (e.g., DD-214, VA letter, Statement of
Service), if applicable
o Transcripts, if applicable
PRIVACY ACT STATEMENT: Sections 1301, 3302, 3502 of Title 5, U.S. Code provide for the
issuance of rules governing the competitive service and authorize solicitation of this information.
Gaining and releasing activities use this information to place registrants, report actions and update data as
well as refer names to potential employers or to provide information to you about potential employment.
Furnishing the requested information is voluntary, but failure to provide it may result in missed
opportunity for proper placement or reemployment under the respective placement assistance program.
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Completed 2 March 2021

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