Form Ds-174 - Application For Employment As A Locally Employed Staff Or Family Member Page 2

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SECTION 4: WORK EXPERIENCE
Paid and voluntary – Please begin by listing your most current work experience and go back 10 years (or longer, if relevant for the
job)
Job Title
From (mm-yyyy)
To (mm-yyyy)
Yearly salary (Local Currency)
Full Time
Part time
Employer Name, Address and Phone Number
Supervisory Responsibilities?
Supervisor Name
Yes
No
Main Duties and Responsibilities
Reason for leaving
Job Title
From (mm-yyyy)
To (mm-yyyy)
Yearly salary (Local Currency)
Full Time
Part time
Employer Name, Address and Phone Number
Supervisory Responsibilities?
Supervisor Name
Yes
No
Main Duties and Responsibilities
Reason for leaving
Job Title
From (mm-yyyy)
To (mm-yyyy)
Yearly salary (Local
Currency)
Full Time
Part time
Employer Name, Address and Phone Number
Supervisory Responsibilities?
Supervisor Name
Yes
No
Main Duties and Responsibilities
Reason for leaving
DS-174
Page 2 of 3

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