ML23144A241

NRC 212 (OMB Copy 2) (12-05-2022)

ML23144A241
Person / Time
Issue date:	06/16/2023
From:	NRC/OCIO
To:
Shared Package
ML23144A235	List: ML23144A241
References
Download: ML23144A241 (1)

Text

NRC FORM 212 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0033 EXPIRES: (MM/DD/YYYY)

(MM-DD-YYYY)

NRC MD 10.1 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, QUALIFICATIONS INVESTIGATION 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 PROFESSIONAL, TECHNICAL, AND 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; ADMINISTRATIVE POSITIONS 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.

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.

Name of Applicant:

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 Applicant's position with your company: Confirmed Dates of Employment Start Date (MM/DD/YYYY) End Date (MM/DD/YYYY)

TECHNICAL AREA:

Above Average Average Below Average How would you rate the applicant's knowledge of the work?

Above Average Average Below Average How well did the applicant perform the duties of the position?

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) Page 1 of 2

NRC FORM 212 U.S. NUCLEAR REGULATORY COMMISSION (MM-DD-YYYY)

NRC MD 10.1 QUALIFICATIONS INVESTIGATION PROFESSIONAL, TECHNICAL, AND ADMINISTRATIVE POSITIONS (Continued)

CHARACTERISTICS:

Above Average Average Below Average Was the applicant dependable?

Above Average Average Below Average How did the applicant work in stressful situation?

How would you describe the applicant's relationship with:

Co-workers?

Supervisors?

Higher Officials?

REQUIRED QUESTIONS:

1. Have you any reason to question this applicant's trustworthiness or loyalty to the U. S.? Yes No

2. Do you know of any personal habits or characteristics that would make this applicant unsuitable for employment by the U. S. Government?

Yes No

3. Is this applicant eligible for re-hire in your organization? Yes No Relationship to Applicant: Supervisor Co-worker Professional Other (Specify):

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.

My Identity May be Revealed I Request My Identity be kept Confidential Typed Name and/or Title of Interviewer Signature of Interviewer Additional Comments NRC FORM 212 (MM-DD-YYYY) Page 2 of 2