Please Print These Instructions Before Use!

PLEASE PRINT THESE INSTRUCTIONS BEFORE USE!

General Information:This SSA-45 was designed using Microsoft Word. It was formulated through the use of tables and

custom drawing objects. No longer do you have to worry with the frustration of Word Perfect’s

line draw or typeover mode. Simply enter your data, spell check it and print it!

Instructions:There are several ways to use this 45. The easiest way I have found is to download it to disk

and copy it into your Briefcase. Once this is accomplished you simply open up your Briefcase and

click on the file named WORD45. Doing this will take you right into Microsoft Word.

Features:Expandable text boxes which automatically accommodate to the amount of text you enter. Text

justification and scaleable font ability within each individual cell. Easy movement throughout the

form by using the TAB key. SSA Form 1360.

Notes:When at the last cell within a group of cells, do not use the TAB key. Doing this will add an additional

cell. Please use your arrow keys or mouse. If this does occur, immediately hit the UNDO key and the

unwanted cell will be deleted.

Support:I designed this 45 to be used by the entire Agency. If there are any questions or comments, please feel

free to contact me.

Office of Finance

Attention: Gary Smith

2-F-7 Annex Building P.O. Box 47 Phone Number: (410) 965-0597

Baltimore, MD 21235Fax Number:(410) 965-9248

Enjoy!

Under the provision of P.L. 93-579 (Privacy Act) you are advised that 5 U.S.C., 3361 authorizes the Social Security Administration to collect the personal information requested on this form. Your response is voluntary.

The information you provide will be used for determining your qualifications for promotion or reassignment. There will be no other uses made of this information. If you do not provide the required information, it will not be possible to consider your application for promotion or reassignment.

Information Regarding Disclosure of Your Social

Security Number Under Public Law 93-579 Section 7 (b)

Disclosure by you of your social security number (SSN) is mandatory to obtain the services, benefits or processes that you are seeking. Solicitation of the SSN by the Social Security Administration is authorized under provisions of Executive Order 9397, dated November 22, 1943.

APPLICATION FOR PROMOTION OR REASSIGNMENT CONSIDERATION

PLEASE READ THE INSTRUCTIONS CAREFULLY

Job Title Of Vacancy / Grade / Ann. Number / Date Of Ann.
Location Of Vacancy / Personnel Contact / Information Ext.

DETACH THIS TOP PORTION AND KEEP FOR YOUR RECORDS

Announcement
Number / Present
Grade / Highest Grade
Held / Date Of
Announcement
I Would Accept A:
Promotion / Reassignment / Change To Lower Grade
Position Downtown / Position In Woodlawn
First 3 Letters Of
Your Last Name / Your Social Security Number
1 / 2 / 3 / 21 / 22 / 23 / 24 / 25 / 26 / 27 / 28 / 29
Name (Printed) / Organization Location

Form SSA-1360 (6-82)

EXPERIENCE AND QUALIFICATIONS STATEMENT FOR POSITION VACANCY
Announcement
Number / Position Applied For / Vacancy Location / Grade Level (s)
Applied For / Lowest Grade
Acceptable
Name (Last, First, Middle / Home Address (For Vacancies In SSA Field Offices)
Social Security Number / Current Duty Station And Address / Office Telephone Number

I. EXPERIENCE (Begin with most recent experience and work back)

You must specify the dates at each grade level if you have had a career ladder position. Be sure to show all experience which is pertinent and related to your qualifications for the positions for which you are applying. Any details to other positions should be described in Part II-Details.
Dates Of Employment In This Position
(Specify The Dates At Each Grade Level) / Exact Title Of Your
Position
Grade / From (Mo., Day, Yr.) / To (Mo., Day, Yr.)
Average Hours Per Week
Civil Service
Series / Employer (Name And Address) / Number And Kind Of
Employees You Supervised / Name And Telephone Of Immediate Supervisor

Detailed Description Of Duties: (Do not attach Position Description)

Dates Of Employment In This Position
(Specify The Dates At Each Grade Level) / Exact Title Of Your
Position
Grade / From (Mo., Day, Yr.) / To (Mo., Day, Yr.)
Average Hours Per Week
Civil Service
Series / Employer (Name And Address) / Number And Kind Of
Employees You Supervised / Name And Telephone Of Immediate Supervisor

Detailed Description Of Duties: (Do not attach Position Description)

II. DETAILS AND DEVELOPENTAL ASSIGNMENTS

List all details or developmental assignments you have participated in for 30 calendar days or longer which are relevant to the position being filled. Specify beginning and ending dates and give a brief description of the duties performed. If more space is needed, provide information in same format on blank sheet or use Continuation Form-45A
Date Began
(MM/DD/YY) / Date Ended
(MM/DD/YY) / Duties While On Detail

III. TRAINING AND SELF-DEVELOPMENT RELEVANT TO POSITION VACANCY

Training and self-development activities may include but are not limited to OPM training courses, SSA
training courses , Adult Education courses, training received in private industry, courses at Trade or
Vocational Schools, Armed Forces training, and Business College courses, as well as formal education.
High School
Graduate? / Years
Completed / Total Credits Received / Credit Earned Per
Course
A. Name Of College Or University Attended / Day / Night / Sem. / Qtr.
Hrs. / Type Of
Degree
Earned / Major Relevant
Courses/Subjects / Sem. / Qtr.
Hrs.
B. School Or
Training Facility / Dates
Attended / Title of Course or Subject / Total
No. Of Hours / Full Or
Part
Time / Certificate
Received?

IV. PERTINENT OUTSIDE ACTIVITIES (Refer to Factors and Weights for Position Vacancy)

Outside Activities generally fall in the category of pertinent civic, welfare, service and organizational activity performed either with or without compensation. List all outside activities which you have participated in, and which you believe are relevant to the position for which you are applying, as mere membership alone will not be given credit. Please be specific as to your actual degree of participation. Include the amount of time (weekly, monthly, etc.) spent on these activities.
Date Began
(mm/dd/yy) / Date Ended
(mm/dd/yy) / Organization / Position
Held / Briefly Describe Your Participation / Amount Of
Time Spent

V. AWARDS-LIST ALL JOB-RELATED AWARDS

Type Of Award, Special
Achievement, HQI Or
Other / Month And Year
Of Award / Grade Level
At Time
Of Award / Brief Summary Of Award

VI. HIGHEST GRADE HELD

Enter Highest Grade Held In Federal Service

VII. SKILLS

Typing WPM / Shorthand WPM / Card Punching CPM
Other:
Ability To Speak Or Write In A Language Other Than Language
Language:
Speech / Comprehension / Translation
Fluent / Passable / Good / Fair / Good / Fair

IX. SSA AND OPM TESTS TAKEN

SSA Test Title / Score / Date / OPM Test Title / Score / Date

VIII. PANEL INTERVIEW RESULTS (For meet and deal positions)

Panel Interview Taken? / Rating / Date / Attach Copy of Results
I certify that the statements made by me on this form are true, complete, and correct to the best of my knowledge and belief and are made in good faith. Falsification of any information on this form is punishable by fine or imprisonment under U.S. CODE TITLE 18, SEC. 1001.
Signature: / Date: