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Office, Board, Division, Bureau:
Name of Appointee:
Title and Organizational Location of Appointee:
Evaluation of Qualifications Based on Completed Federal Application or Resume:
Statement of Duties and Justification of Need for the Position as an Expert or Consultant:
Daily or Hourly Rate of Pay and Justification of Rate:
Tour of Duty:
| Intermittent____ |
Estimated Number of Days to be Worked_____ |
| Regular Tour of Duty ___ |
Description of Tour__________________ |
Effective Date of Appointment:
Expiration Date:
Reappointment Date:
Appointment Authority: 5 U.S.C. 3109
Certificate of Understanding: A Certificate has been
obtained from the appointee.
YES ___ NO ___
Expert/Consultant Certificate: A Certificate has been completed.
YES___ NO___
Additional Comments:
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