Geographic Availability Statement
Paperwork Reduction Act Notice: This form is used in considering applicants
for the Senior Executive Service Candidate Development Program and other
executive positions. Your response is voluntary; however, your failure to
provide this information could effect your consideration for this program. This
signed statement will remain the minimum area of availability and will be used
for future job placement consideration. Employees must secure the approval of
the Executives Resources Board for any change in their area of availability.
Based upon your experience and prior assignments, you will be considered for
any Board covered position located in the area of your geographic availability.
The cities listed below are not all inclusive but are intended to provide you with
a general idea of where IRS offices do or may exist.
Availability for Headquarter Operations in Washington, DC and/or Atlanta is required.
I am available for all locations.
I am available for only those locations marked below. (You must mark all locations for which you are
available. If you are only available for Washington, DC and/or Atlanta, you must mark which one or both.)
Atlanta GA
Andover MA
Austin TX
Baltimore MD
Boston MA
Brookhaven NY
Brooklyn NY
Chicago IL
Cincinnati OH
Dallas TX
Denver CO
Detroit MI
Fresno CA
Ft. Lauderdale FL
Greensboro NC
Hartford CT
Houston TX
Indianapolis IN
Remarks
Name (Please type)
Date signedSignature
Form 8569 (Rev. 4-2006) Catalog Number 63618S
Department of the Treasury-Internal Revenue Service
www.irs.gov
You are not required to provide the information requested on a form that is
subject to the Paperwork Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or its instructions must be
retained as long as their contents may become material in the administration of
any Internal Revenue law. Generally, tax returns and return information are
confidential, as required by Internal Revenue Code Section 6103.
The time needed to complete the geographic availability statement is twenty
minutes. If you have comments concerning the accuracy of this time estimate
or suggestions for making this form simpler, we would be happy to hear from
you. You can write to Internal Revenue Service, Tax Products Coordinating
Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6406,
Washington, DC 20224. DO NOT send the completed Geographic Availability
Statement to this office.
Jacksonville FL
Kansas City MO
Laguna Niguel CA
Los Angeles CA
Manhattan NY
Martinsburg WV
Memphis TN
Nashville TN
Newark NJ
New Orleans LA
Oakland CA
Ogden UT
Philadelphia PA
Phoenix AZ
San Francisco CA
Seattle WA
St. Louis MO
St. Paul MN
Washington DC Metropolitan Area
OMB No.
1545-0973
Internal Revenue Service
Attn: Executive Services Division
OS:HC:S Room 3511
1111 Constitution Ave., NW
Washington, DC 20224
Return completed form to
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dd mmm yyyy
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