Form Ds-174 - Application For Employment As A Locally Employed Staff Or Family Member

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OMB APPROVAL NO. 1405-0189
EXPIRES: 5/31/2019
U.S. Department of State
ESTIMATED BURDEN: 1 Hour
APPLICATION FOR EMPLOYMENT AS A LOCALLY EMPLOYED STAFF OR FAMILY MEMBER
POSITION
Vacancy Announcement Number
Position Title
SECTION 1: PERSONAL INFORMATION TO BE COMPLETED BY ALL APPLICANTS
Name (Last, First or Given Name)
Other Names Used
Address
E-mail
Telephone Number
Does your relative work in this Embassy or Consulate? If yes, tell us their name and the section where they work.
Are you able to legally work in this country? Yes
No
(U.S. Government does not sponsor work visad unless specified on the Vacancy Announcement)
If this job includes driving a U.S. Government vehicle, do you have a current and valid driver’s license?
Yes
No
SECTION 2: EDUCATION
High School/Secondary Education
Dates Attended
Did you
(Name, City)
(mm-yyyy)
graduate?
From
Yes
To
No
Trade/Technical
Dates Attended
Did you
Certificate/Diploma
Major Subject
(Name, City)
(mm-yyyy)
graduate?
From
Yes
To
No
Undergraduate/Bachelor’s Degree
Dates Attended
Did you
Degree/Diploma
Major Subject
(Name, City)
(mm-yyyy)
graduate?
From
Yes
To
No
Graduate Degree
Dates Attended
Did you
Degree/Diploma
Major Subject
(Name, City)
(mm-yyyy)
graduate?
From
Yes
To
No
SECTION 3: LANGUAGES
Languages
1 Basic – Examples: Basic greetings, phrases, numbers and signs.
2 Limited – Examples: Directions, simple questions.
3 Good Working Knowledge – Examples: Conversations about familiar topics, complex documents.
4 Fluent – Examples: Infer nuanced meaning from complex documents.
5 Translator – Examples: Certified professional translator in this language.
Language
Speaking (Provide level)
Reading (Provide level)
Writing (Provide level)
DS-174
Page 1 of 3
05-2017

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