Form Ds-174 - Application For Employment As A Locally Employed Staff Or Family Member - U.s. Department Of State Page 3

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LICENSE, SKILLS, TRAINING, MEMBERSHIP, AND RECOGNITION
22. List professional licenses, certifications, typing/keyboard, computer skills, formal and on-line training, and other skills
and abilities you consider relevant to the position. Please include the license or certification number. Attach a copy if
the license or certification is a requirement of the position. If licensed in the U.S., please list the state of issuance. If
licensed in another country, please list the province/state/region and country of issuance. (Use additional pages, as
required)
23. List professional organizations, associations, awards, honors, fellowships, and publications you consider significant.
LANGUAGES
24. List your languages, the appropriate competency levels, and your primary/first spoken/native language using the
language standards below. You may only identify one primary/first spoken/native language.
Language Indicators:
Level I = Basic Knowledge
Level IV = Fluent
Level II = Limited Knowledge
Level V = Professional Translator/Interpreter
Level III = Good Working Knowledge
Write
Language
Speak
Read
Primary Language?
No
Yes
No
Yes
No
Yes
No
Yes
WORK EXPERIENCE
Include all work experience, paid and voluntary. Start with your present or most recent work experience. When
describing work, list specific duties/responsibilities and accomplishments. Include supervisory responsibilities and the
number of employees supervised. Go into as much detail as possible for work experience that directly relates to the
advertised position. Include all periods of unemployment and the reason. (Use additional pages, as required)
25a. Job Title (If U.S. Government, include the Series and Grade)
Hours per Week
Salary per Year in U.S. Dollars or
From
To
Local Currency
(mm-dd-yyyy)
(mm-dd-yyyy)
Employer's Name and Address
Supervisor's Name and Contact Information
Name
Phone Number
E-mail Address
May HR contact your current supervisor?
Yes
No
DS-174
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