Appendix G – FAC-COR Functional Experience Transcript Form

(Required for FAC-COR Levels II and III)

Open this form as a .DOC

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): _____________________________________

□ I am applying for FAC-COR Level II
□ I am applying for FAC-COR Level III

PART B – EXPERIENCE

Please provide employment dates, agency/firm, position title, years of experience, and accomplishment narratives for each competency listed below.  FAC-COR Level II requires at least 1 year of COR experience within the last 4 years. 
FAC-COR Level III requires at least 2 years of COR experience on federal projects within the last 4 years. 

General Business Qualifications

Professional Experience Profile for FAC-COR Qualifications:

□ FAC-COR Level II:  My experience includes at least 1 year of COR experience within the last 4 years.  My knowledge and abilities applicable to Level II competencies are described in the narratives below.

□ FAC-COR Level III:  My experience includes at least 2 years of COR experience within the last 4 years on federal projects.  My knowledge and abilities applicable to Level II competencies are described in the narratives below.

Competency 1: Attention to detail, decision-making, flexibility, influencing/negotiating, integrity/honesty, interpersonal skills, oral communication, planning and evaluating, problem solving, project management, reasoning, self-management, teamwork, and writing.

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

Competency 2: Acquisition Planning

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

Competency 3: Market Research

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

Competency 4:  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 the competency stated above:

Competency 5:  Effective Pre-Award Communication

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

Competency 6:  Technical Analysis of Proposals

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

Competency 7:  Negotiation

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

Competency 8:  Effective Contract Management

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

Competency 9:  Performance Management

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

If you are applying for FAC-COR Level III, please address the additional competencies below:

Competency 10:  Constructing a Work Breakdown Structure

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

Competency 11:  Preparing Project Analysis Documents

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

Competency 12:  Tailoring Acquisition Documents

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

Competency 13:  Analyzing and/or Developing Requirements

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

Competency 14:  Monitoring Performance

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

Competency 15:  Assisting with Quality Assurance

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

Competency 16:  Budget Development

• Employment dates:
• Agency/Firm:
• Position Title:
• Years of Experience (relating to this competency):
• Briefly describe your experience relating to the competency stated above:

PART C – SIGNATURE

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

Applicant’s signature ________________________________Date_______________

Links to the FAC-COR Handbook:

• FAC-COR Handbook (PDF-53 pages)
  • Executive Summary of the FAC-COR Handbook
  • Chapter 1: Implementation of HHS’ FAC-COR Program
  • Chapter 2: Requirements and Performance Accountability
  • Chapter 3: Application and Certification Procedures
  • Chapter 4: Certification Management
    • Appendix A: HHS’ COR Responsibilities
    • Appendix B: FAI’s Key Competencies for CORs
    • Appendix C: FAC-COR Curriculum Guidance
    • Appendix D: FAC-COR Guidance on Meeting Requirements for Continuous Learning Points
    • Appendix E: FAC-COR Appointment Letter Template
    • Appendix F: FAC-COR Certification Action and Training Request Form
    • Appendix G: FAC-COR Functional Experience Transcript Form
    • Appendix H: FAC-COR Certification through Fulfillment Form
    • Appendix I: FAC-COR Certification Waiver Request Form