ML22348A261
| ML22348A261 | |
| Person / Time | |
|---|---|
| Issue date: | 02/08/2023 |
| From: | NRC/OCIO |
| To: | |
| Shared Package | |
| ML22269A535 | List: |
| References | |
| Download: ML22348A261 (2) | |
Text
NRC FORM 212 (MM-DD-YYYY)
QUALIFICATIONS INVESTIGATION PROFESSIONAL, TECHNICAL, AND ADMINISTRATIVE POSITIONS U.S. NUCLEAR REGULATORY COMMISSION NRC MD 10.1 APPROVED BY OMB: NO. 3150-0033 EXPIRES: (MM/DD/YYYY)
Estimated burden per response to comply with this mandatory information collection request:
30 minutes. This information is used to determine the qualifications and suitability of external applicants for employment. Send comments regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by email to Infocollects.Resource@nrc.gov, and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0033), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; email: oira_submission@omb.eop.gov. The NRC may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the document requesting or requiring the collection displays a currently valid OMB control number.
NRC FORM 212 (MM-DD-YYYY)
Page 1 of 2 Start Date (MM/DD/YYYY)
Above Average Name of Applicant:
The applicant named below has applied for a position in the NRC. Please rate the applicant in the items listed below with respect to the period of time you either supervised or were acquainted with the applicant. Include any comments you may feel are relevant. Please return the completed form to the Human Resources Specialist listed in the "FROM" block by the return date indicated.
Position for which applied:
From:
To: (Name and title of supervisor or reference Human Resources Specialist Office of the Chief Human Capital Officer U. S. Nuclear Regulatory Commission Washington, DC 20555 Confirmed Dates of Employment End Date (MM/DD/YYYY)
Applicant's position with your company:
TECHNICAL AREA:
How would you rate the applicant's knowledge of the work?
Average Below Average Above Average How well did the applicant perform the duties of the position?
Average Below Average Above Average Average Below Average How well did the applicant manage the workload?
What were his/her strengths?
What were his/her weaknesses?
NRC FORM 212 (MM-DD-YYYY)
U.S. NUCLEAR REGULATORY COMMISSION NRC MD 10.1 QUALIFICATIONS INVESTIGATION PROFESSIONAL, TECHNICAL, AND ADMINISTRATIVE POSITIONS (Continued)
How would you describe the applicant's relationship with:
CHARACTERISTICS:
REQUIRED QUESTIONS:
- 1. Have you any reason to question this applicant's trustworthiness or loyalty to the U. S.?
- 2. Do you know of any personal habits or characteristics that would make this applicant unsuitable for employment by the U. S. Government?
- 3. Is this applicant eligible for re-hire in your organization?
Relationship to Applicant:
NOTE: Consistent with the Privacy Act of 1974, this evaluation may be revealed to the applicant upon his or her request.
However, if you request, your identity and other identifying information will be kept confidential.
Above Average Average Below Average Was the applicant dependable?
Above Average Average Below Average How did the applicant work in stressful situation?
Co-workers?
Supervisors?
Higher Officials?
Yes No Yes No Yes No Supervisor Co-worker Professional Other (Specify):
My Identity May be Revealed I Request My Identity be kept Confidential Typed Name and/or Title of Interviewer Signature of Interviewer Additional Comments Page 2 of 2 NRC FORM 212 (MM-DD-YYYY)
SIGN