Vacancy number and position
Two blocks at the top for the vacancy number and the position.
GSA3412
Initial Screening Worksheet for Merit Promotion Action
- Agency
- GSA
- Revision
- Rev. 11/1979
- Fillable fields
- 119
- Pages
- 1
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 3412: Initial Screening Worksheet for Merit Promotion Actions
GSA Form 3412, Initial Screening Worksheet for Merit Promotion Actions, is a General Services Administration form dated 11-79 in its footer, and GSA hosts it in its forms library. GSA's page lists it as Initial Screening Worksheet for Merit Promotion Action and gives no authority or regulation.
The one-page worksheet has a vacancy number and position at the top, then 23 rows. Each row has the date received, the candidate's name, title, series, grade and office, a rating of qualified or not qualified, and the reason for a not qualified rating.
It ends with a date and the signature of the personnel representative. The form prints no instructions, filing address or OMB number. You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 3412
Date received
The first column of each row, for the date the candidate's entry was received.
Candidate's name, title, series, grade, office
One column for the candidate's name, title, series, grade and office.
Rating
Two columns under Rating, printed QAUL. and NOT QAUL., for qualified and not qualified.
Reason for not qualified rating
The last column of each row, for the reason a candidate is rated not qualified.
Date and signature
A date and the signature of personnel representative at the bottom.
How to complete GSA Form 3412
- 1
Enter the vacancy
Fill in the vacancy number and the position at the top.
- 2
Log each candidate
On each row, enter the date received and the candidate's name, title, series, grade and office.
- 3
Mark the rating
Mark the qualified or not qualified column for each candidate.
- 4
Give the reason for not qualified
For a candidate rated not qualified, fill in the reason column.
- 5
Date and sign
The personnel representative dates and signs at the bottom.
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Where it goes and what the form says
Where it goes
The PDF gives no filing address, routing or instructions.
Edition and authority
The footer prints GSA FORM 3412 (11-79). GSA's page lists 11/1979 as the current revision date and leaves the authority or regulation blank.
What the form leaves out
The PDF prints no privacy notice, OMB number or burden estimate.
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The form prints no instructions. These are the roles its blocks name.
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Questions about Form GSA3412
Who issues GSA Form 3412?
The footer prints General Services Administration and GSA FORM 3412 (11-79). GSA hosts it in its forms library.
Who signs GSA Form 3412?
The form has one signature line, for the personnel representative, with a date.
What ratings does the worksheet use?
Two columns under Rating, for qualified and not qualified, and a column for the reason for a not qualified rating.
How many candidates fit on one worksheet?
The form prints 23 candidate rows under one vacancy number and position.
Does GSA Form 3412 come with instructions?
No. The PDF prints only the blocks and rows, with no instructions, filing address or OMB number.