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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LANGUAGES
19. 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 II
Limited Knowledge
Level III
Good Working Knowledge
Level IV
Fluent
Level V
Professional Translator/Interpreter
Language Level To:
Speak
Read
Write
Primary -
WORK EXPERIENCE
20. 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 needed.)
20a. WORK EXPERIENCE
20a. Job Title (If U.S. Government, include the series and grade)
From (mm-yyyy)
To (mm-yyyy)
Salary per Year in U.S. Dollars or Local Currency
Hours per Week
Employer's Name and Address
Supervisor's Name and Contact Information
Name
Phone Number
E-mail Address
Were you a supervisor in this position?
May HR contact your supervisor?
Yes
No
Yes
No
If yes, how many people did you supervise?
Describe your major duties/responsibilities and accomplishments.
Reason(s) for Leaving (Do not write "N/A" or "not applicable".)
DS-174
Page 3 of 6
05-2016

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