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RATING OF AIR TRAFFIC EXPERIENCE FOR AT MOVEMENT
IMPORTANT
Read the following instructions carefully Before filling out this application. · You must furnish all requested information. The information you provide will be used to determine you qualifications and rating. Do not submit a resume in lieu of completing this form. · If you fail to answer all questions fully and accurately, you may lose employment opportunities. · So that it is understood that you did not omit an item, please write the letters "N/A" (not applicable) beside those items that do not apply to you. · Read the vacancy announcement (if applicable) for the position advertised to be certain that your experience and education meet the requirements. · Be sure to include all forms that may be required. -- FAA Form 3330-42, Request for Transfer Consideration and Acknowledgement. -- FAA Form 3330-43-1, Rating of Air Traffic Experience for AT Movement -- Any other information required by the position vacancy announcement. · Submit the above along with a stamped envelope, addressed as directed in the vacancy announcement, to your rating official on or before the vacancy closing date (if applicable). · This form is to be used for applications for CPC positions only.

Read the Privacy Act Requirements Notice Below. Detach it and retain it for your records. Please read the instructions below before completing this form
Do not make any entries in the shaded areas. They are reserved for the rating official. The TALLY is also for the rating official's use. The upper right corner of the form pertains to the vacancy announcement, if applicable. Enter the appropriate information exactly as it appears on the vacancy announcement. If you need more space than has been provided for a given item, continue on an 8 1/2 x 11" sheet of paper with the items numbered to correspond to the items continued. Place your name and vacancy number (if applicable) in the upper right hand corner and attach to the form.

PRIVACY ACT REQUIREMENTS (P.L. 93-579) This form is used to determine qualifications and is authorized under Title 5 of the U.S. Code, Sections 3302 and 3361. It must be submitted in order for you to be considered for the position being advertised or for consideration under a voluntary internal transfer request. The information will be used for FAA human resource management related purposes and will not be transmitted outside the agency except as provided by law. Providing the information requested on this form is not mandatory, but if you fail to give us the complete data, we cannot give you a rating. We must have your Social Security Number (SSN) to keep your records straight because other people may have the same name.

INSTRUCTIONS Rating of Air Traffic Experience for AT Movement

Candidate Information.
Self-explanatory.

Selective Placement Factors.
Check the appropriate box. Candidates who have not satisfied appropriate selective placement factors are not qualified for the vacancy.

Example: A developmental employee successfully completed 2 phases of training at an ATC-11 facility and then moved to, and completed, 1 phase of training, at an ATC-9 facility. This employee would receive points for phases completed only at the highest ATC level facility: ATC-11 = 7 X 2 phases completed = 14 points. Total for Factor 1 would be 14.

TALLY
For use of Rating Official only. Use Tally to record values for each factor. Add up the total score and enter it in the box at top right of form. Normally, the employee's firstlevel supervisor is the rating official.

FACTOR 2 - Aviation Experience. (Max 5 pts.)
Points are credited for each certificate or rating obtained.

Aviation Experience
Certificate/ Rating Private Pilot Commercial Pilot Instrument Rating CFI Dispatcher Certificate Points 1 1 1 1 1

FACTOR 1 - Facility Complexity Level.
(Max. 42 pts.) Points are assigned for the highest level ATC facility to which the applicant was permanently assigned and facility/area certified as a CPC. Assign 3 points times the highest level. For employees who are not currently in an ATC facility, use the conversion table below to get the ATC level equivalent. Use the table to convert FPL level FG/GS to ATC levels. Award the point value that would provide the maximum benefit to the employee.
Facility FPL Level FG/GS 9 10 11 12 13 14 Equivalent ATC Level 1 3 5 7 9 11

FACTOR 3 - Experience and Recency. (Max.
50 pts.) Assign 2 points for each full year in a ATS2152 position. Deduct 1 point for each full year s ince certification was lost. For CPC positions, deduct 1 additional point for each full year since the candidate served in an ATS terminal or center CPC position. Example: An applicant with 10 years ATS 2152 time; (5 years Terminal or Center CPC, 3 years facility staff, 2 years regional office experience) is bidding on a Teminal/Center CPC position. Credit employee: ATS-2152 time = 10X2 = 20 points. Certification not required as facility or regional office staff = [-(3+2)} = -5 points. 5 Years since last a Terminal/Center CPC=5 x (-1) = -5 points. Total=20 -5 -5 = 10 points total. Example: Employee has 3 years ATS 2152 developmental experience in Terminal or Center option bidding on an ATS Terminal/Center CPC position. Employee is credited with ATS time, 3 X 2 = 6 points for this factor. (DoD 2152 time is not credited for Factor 3.)

Example: An applicant with 5 years as FG-13, and 1 year at ATC-10 facility. The FG-13 = 9 x 3 = 27 while ATC-10 = 10 x 3 = 30 points. For developmental applicants who have never achieved CPC status, credit the following points for each developmental stage successfully completed at the highest ATC level facility to which they were permanently assigned. [This section does not apply to CPCs in training status (CPCIT)]
ATC LEVEL POINTS ATC LEVEL POINTS

FACTOR 4 - Education and Self Development. (Max. 25 pts.)

Complete all appropriate items as listed on the form. Correspondence courses are to be listed on a separate sheet by title and dates completed.

12 11 10 9

7 7 6 6

8 7 6 5

5 5 4 4

FACTOR 5- Awards . (Max. 10 pts.) This factor
credits awards and recognition. Complete all appropriate items as listed on the form.

Rating of Air Traffic Experience for AT Movement
TALLY FACTOR Max. Score Pts. Vacancy Number Vacancy Position Title

Score of Candidate Series and ATC and Career Level Codes

AT-2152Vacancy Closing Date Facility Location/Region

1 2 3 4 5

42 5 50 25 10

Name of Candidate

Present Series, ATC/Career Level, and Loc. Social Security Number

Current Supervisor

Location/Region

Office Phone Number

Selective Placement Factor
Total Score
Position, Title, ATC and Career Level

Not Satisfied
Facility Fac. I. D. Type Level

Satisfied
Dates (Mo/Day/Yr) Area/FAC Certification From

Not Applicable
Value
Cred. To Time (Mo.)

FACTORS 1 Facility Complexity Level (Assign 3 points times the highest ATC level facility)

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) FAA Form 3330-43-1 (6/00)

FACTOR 2 Aviation Experience (One point for each rating or certificate checked; Maximum 5 points). Private Pilot Commercial Pilot Instrument Rating Certified Flight Instructor Dispatcher Certificate

FACTOR 3 ­Experience and Recency (Maximum 50 points) 3a. Experience (Assign 2 points for each full year in an ATS 2152 series position.) 3a________ - 3b_________ =

3b. Recency ­ (Deduct 1 point for each full year since certification was lost. For a CPC position deduct an additional 1 point for each full year since in an ATS terminal or center CPC position.) FACTOR 4 Education and Self-Development (Maximum 25 points) 4a. Credit undergraduate college work at 30 semester hours or 45 quarter credits = 1 year. Credit graduate college work at 18 semester hours or 27 quarter credits = 1 year. Education in increments of less than 1 year may be prorated in half-year increments in accordance with the following table. Award credit only for the highest level attained by the applicant. Circle appropriate credit. (Must be from an accredited institution) COLLEGE EDUCATION CREDIT TABLE 1 year of college 3 1.5 yrs. of college 4 2 years of college 5 Associate's Degree 6 2.5 yrs. of college 6 3 years of college 7 3.5 yrs. of college 8 *Type of Degree: School:
4b. FAA Correspondence Courses List Course Titles and Dates Completed on Separate Sheet and attach to Application (Maximum 2) 4c. Long-Term Training Date Completed (5 points)

4 yrs. of college 9 Bachelor's Degree* 10 1 year of graduate work 12 2 yrs. of graduate work 14 Master's Degree* 15 3 yrs. of graduate work 17 Doctorate* 20 Date: (points)

TOTAL

4b

FACTOR 4 GRAND TOTAL 4a ___________ + 4b ___________ + 4c___________

= (Maximum 25)

FACTOR 5 Awards (Maximum 10 points ). Award the following points for recognition granted to employees: Presidential Monetary Award = 5 pts. Outstanding Rating = 4; FAA Award for Superior Achievement = 4; Quality Step Increase = 3; Exceptional Rating = 2; Special Achievement Award= 2; On-the-Spot Cash Award, Certificate of Achievement, Time Off Award Official Letter of Commendation, Suggestion Award = .5 point for each (maximum 2 pts); (NOTE: Quality Step Increases or Special Achievement Award given in conjunction with an Outstanding Rating receive outstanding rating credit only.

Type

Date

Value

Type

Date

Value

Type

Date

Value

Type

Date

Value

O = Outstanding Rating Q = Quality Step Increase E = Exceptional Rating

SAA = Special Achievement Award COM = Ltr. of Commendation SUG = Suggestion Award

OTS = On-the-Spot CA = Certificate of Achievement TOA = Time Off Award

PMA = Presidential Monetary Award

CERTIFICATION OF CANDIDATE I certify that all of the statements : made in this application are true, complete, and correct to the best of my knowledge and belief and are made in good faith.

CERTIFICATION OF RATING OFFICIAL: I certify that this rating is true, complete, and correct to the best of my knowledge and belief. Date Signature of Rating Official

Date

Signature of Candidate

FAA FORM 3330-43-1 (6/00)