Form Ds-174 - Application For Employment As A Locally Employed Staff Or Family Member - U.s. Department Of State Page 6
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15PRIVACY ACT STATEMENT
(for U.S. Citizens and Legal Permanent Residents of the U. S.)
The information is sought pursuant to, e.g., the Foreign Service Act of 1980, as amended, and
AUTHORITIES:
22 U.S.C. 2669(c)
PURPOSE: The information solicited on this form is necessary to establish your eligibility and qualifications for
advertised positions. The information furnished may also be used in the pre-employment fitness-for-duty process, if
you are selected for a Mission position. We are authorized to solicit your social security number (SSN) by Executive
Order 9397 to confirm the identity and employment eligibility of the individual. The SSN may also be used to seek
information about you from employers, schools, banks, and others who know you. Disclosure of this information,
including your social security number, is voluntary. Failure to provide the information requested on this application
may result in delays in considering your application. It could result in you not receiving full consideration for the
position. Incomplete addresses slow processing of your application.
ROUTINE USES: The information you provide in this form may be shared with Federal, State, local, and foreign
agencies to the extent relevant and necessary for that agency's decision about you. This information may be
disclosed to a member of Congress or to a congressional staff member in response to an inquiry of the
Congressional office made at the written request of the constituent etc. This information may be disclosed to a
member of Congress or to a congressional staff member in response to an inquiry of the Congressional office
made at written request of the constituent about whom the record is maintained. Information may also be
disclosed in the course of presenting evidence to a court, magistrate, or administrative tribunal, including
disclosures to opposing counsel in the course of settlement negotiations.
BURDEN: Public reporting burden for this collection of information is estimated to average 60 minutes per
response, including time required for searching existing data sources, gathering the necessary documentation,
providing the information and/or documents required, and reviewing the final collection. You do not have to
supply this information unless this collection displays a currently valid OMB control number. If you have
comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to:
A/GIS/DIR, Room 2400 SA-22, U.S. Department of State, Washington, DC 20522-2202
EQUAL OPPORTUNITY STATEMENT
The United States Government is an equal opportunity employer.
DS-174
Page 6 of 7
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