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Appendix H – FAC-COR Certification through Fulfillment Form

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PART A – APPLICANT IDENTIFICATION

Enter the required following information:

Name (Last, First, Middle Initial) ____________________________________________

E-mail Address __________________ Phone _____________ Fax ______________

Organization Name ____________________________________________

Organization Address __________________________________________

Title, Series, Grade ___________________________________________

What type(s) of contract(s)/project(s) are you managing?

□ Information Technology
□ Construction
□ Advanced Research and Development
□ Other (Please Specify): _____________________________________

FAC-COR is a competency-based program, requiring those who seek certification to demonstrate satisfactory proficiency in the required competencies. Fulfillment applies only to initial certification. Individuals who have served in the COTR role and participated in COTR training previous to the HHS FAC-COR program may seek recognition for fulfillment of the FAC-COR requirements and demonstrate their proficiency by completing this fulfillment request.

q I am applying for FAC-COR Level I Certification through Fulfillment
q I am applying for FAC-COR Level II Certification through Fulfillment
q I am applying for FAC-COR Level III Certification through Fulfillment

PART B– EXPERIENCE

Complete the tables below, demonstrating your proficiency in each general business competency and each technical contracting competency and aligned skill. You may attach other documents that demonstrate proficiency in the competencies. A detailed explanation of these competencies can be found at (http://www.fai.gov/acm/cotrcomp.asp).

Please provide employment dates, agency/firm, position title, years of experience for each competency listed below, and accomplishment narratives (as applicable for General Business Competencies and Technical Contracting Competencies).

General Business Competency Qualifications

GB Competency 1: Attention to Detail

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to your ability to thoroughly perform work and be conscientious about attending to detail.

GB Competency 2: Decision-Making

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to making sound, well informed, and objective decisions; perceiving the impact and implications of decisions; committing to action, even in uncertain situations, to accomplish organizational goals; and managing change.

GB Competency 3: Flexibility

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to being open to change and new information; adapting behavior or work methods in response to new information, changing conditions, or unexpected obstacles; and the ability to effectively deal with ambiguity.

GB Competency 4: Influencing/Negotiating

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to persuading others to accept recommendations, cooperate, or change their behavior; working with others towards an agreement; and negotiating to find mutually acceptable solutions.

GB Competency 5: Integrity/Honesty

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to contributing to the integrity of the organization; displaying high standards of ethical conduct and understanding the impact of violating these standards on an organization, self, and others; and trustworthiness.

GB Competency 6: Interpersonal Skills

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to showing understanding, courtesy, tact, empathy; developing and maintaining relationships; dealing with difficult people; relating well to people from varied backgrounds; and sensitivity to individual differences.

GB Competency 7: Oral Communication

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to expressing information to individuals or groups effectively, taking into account the audience and nature of the information; making clear and convincing presentations; listening to others; and attending to nonverbal cues.

GB Competency 8: Planning and Evaluating

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to organizing work, setting priorities, and determining resource requirements; determining goals and strategies; coordinating with other organizations; monitoring progress; and evaluating outcomes.

GB Competency 9: Problem Solving

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to identifying problems; determining accuracy and relevance of information; using sound judgment to generate and evaluate alternatives; and making recommendations.

GB Competency 10: Project Management

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to developing and maintaining a workable plan and managing resources to accomplish the overall goal of the project; ensuring the smooth flow and timely completion of activities that deliver project results; anticipating obstacles or gaps that would impact project success; and working to continuously improve the agency's capability to achieve success.

GB Competency 11: Reasoning

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to identifying rules, principles, or relationships that explain facts, data or other information; and analyzing information and making correct inferences or accurate conclusions.

GB Competency 12: Self-Management/Initiative

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to setting well-defined and realistic personal goals; displaying a high level of initiative, effort, and commitment towards completing assignments in a timely manner; working with minimal supervision; being motivated to achieve; and demonstrating responsible behavior.

GB Competency 13: Teamwork

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to encouraging and facilitating cooperation, pride, and trust; fostering commitment; and working with others to achieve goals.

GB Competency 14: Writing

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to recognizing and using correct English grammar, punctuation, and spelling; communicating information in a succinct and organized manner; and producing written information that is appropriate for the intended audience.

Technical Contracting Competencies

TC Competency 1: Acquisition Planning

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to: documenting the source; methods of payment; contract financing; unpriced contracts; recurring requirements; pricing arrangements; compliance with FAR requirements; determining need for EVM; task and delivery order contracting; and strategic planning . Be sure to include performance achieved and project cost, duration, scope and results – as applicable:

TC Competency 2: Market Research

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to: understanding the marketplace; and collecting source information. Be sure to include performance achieved and project cost, duration, scope and results – as applicable:

TC Competency 3: Defining Government Requirements in Commercial/Non-Commercial Terms

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to: writing statements of work; conducting needs analysis and preparing requirements; and assisting in the development of the acquisition strategy. Be sure to include performance achieved and project cost, duration, scope and results – as applicable:

TC Competency 4: Effective Pre-Award Communication

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to: publicizing proposed acquisitions; subcontracting requirements; solicitation preparation; pre-quote, pre-bid, and pre-proposal conferences; and amending/cancelling solicitations. Be sure to include performance achieved and project cost, duration, scope and results – as applicable:

TC Competency 5: Technical Analysis of Proposals

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to: evaluating non-price factors; pricing information from offerors; and evaluation documentation. Be sure to include performance achieved and project cost, duration, scope and results – as applicable:

TC Competency 6: Negotiation

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to: negotiation strategy; conducting discussion and negotiations; and determining capability. Be sure to include performance achieved and project cost, duration, scope and results – as applicable:

TC Competency 7: Effective Contract Management

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to: contract administration planning and orientations; contract modifications and adjustments; order management, and monitoring contractor performance. Be sure to include performance achieved and project cost, duration, scope and results – as applicable:

TC Competency 8: Performance Management

Employment dates:
Agency/Firm:
Position Title:
Years of Experience (relating to this competency):
Briefly describe your experience relating to: performance metrics; performance management; financial management; contract reporting; inspection and acceptance; and specialized requirements. Be sure to include performance achieved and project cost, duration, scope and results – as applicable:

PART C – SIGNATURES

1. Applicant’s certification (Levels I, II, and III):

I certify that the information provided is accurate, current, complete, and fully supports the certification action request.

Applicant’s signature ________________________________Date_______________

2. Immediate supervisor’s concurrence/non-concurrence (Levels I, II, and III):

I have reviewed and discussed with [applicant’s name] the certification through fulfillment request and the information provided in support thereof. Based on pertinent job performance (if any) and the information provided, I

□ concur with the certification action □ do not concur with the certification action

□ Rationale for non-concurrence, if applicable:

Typed or printed name ___________________________________________________

Signature _________________________________ Date ______________________

3. STAFFDIV/OPDIV Acquisition Career Manager concurrence/non-concurrence (Levels I, II, and III):

I have reviewed the certification action request and the information provided in support thereof. Based on the information provided, I

□ concur with the certification action □ do not concur with the certification action

□ Rationale for non-concurrence, if applicable:

Typed or printed name ___________________________________________________

Signature _________________________________ Date ______________________

Privacy Act Notice: FAC-COR Certification is required for HHS employees that have been or will be delegated authority, by a Contracting Officer, to serve as a COR. Acquisition Career Managers (ACMs) must collect general as well as prescribed training data for this certification program. The legal authority for this data collection is Section 5 U.S.C. Chapter 41. The data will be included in a Departmental database on an HHS intranet website, which will include the first name, last name, and certification expiration date for FAC-COR certified personnel. HHS’ routine uses for the information are provided in System of Records No. 09-90-0018, which is available at http://www.hhs.gov/foia/privacy/recordsnotices/09900018.html. Failure to provide the requested information may result in a denial of an individual’s request for FAC-COR certification.

Links to the FAC-COR Handbook:

FAC-COR Handbook (PDF-53 pages)