Form Ds-174 - Application For Employment As A Locally Employed Staff Or Family Member - U.s. Department Of State Page 7

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DS-174 CONTINUATION SHEET - WORK EXPERIENCE
25_ Job Title (If U.S. Government, include the Series and Grade)
Salary per Year in U.S. Dollars or
Hours per Week
Local Currency
From
To
(mm-dd-yyyy)
(mm-dd-yyyy)
Employer's Name and Address
Supervisor's Name and Contact Information
Name
Phone Number
E-mail Address
Describe your duties/responsibilities and accomplishments.
Describe your reason(s) for leaving. (Do not write "N/A" or Not Applicable)
DS-174 CONTINUATION SHEET - WORK EXPERIENCE
25_ Job Title (If U.S. Government, Include the Series and Grade)
Salary per Year in U.S. Dollars or
Hours per Week
Local Currency
From
To
(mm-dd-yyyy)
(mm-dd-yyyy)
Employer's Name and Address
Supervisor's Name and Contact Information
Name
Phone Number
E-mail Address
Describe your major duties/responsibilities and accomplishments.
Describe your reason(s) for leaving. (Do not write "N/A" or Not Applicable)
DS-174
Page 7 of 7

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