Form Ds-174 - Application For Employment As A Locally Employed Staff Or Family Member Page 2
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1216. What days are you available to work as part of a regularly scheduled work week? (Check all that apply.)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
17. Do any of your relatives or members of your household work for the United States Government?
Yes
No
If yes, provide the details below. If you need more space, use an additional sheet of paper. (See Instructions for Completing the DS-174 for the
definition of relatives and members of household.)
Name
Relationship
Agency, Position, and Location
U.S. CITIZEN ELIGIBLE FAMILY MEMBER (USEFM) AND U.S. VETERANS HIRING PREFERENCE
18. Are you claiming preference in hiring under U.S. law, including the Foreign Service Act of 1980, based upon your status as either a U.S.
Citizen Eligible Family Member (USEFM) or U.S. Veteran? See Instructions for Completing the DS-174 for additional information about the
USEFM and U.S. Veterans hiring preference. (Check only one.)
Yes, I am a U.S. Citizen EFM and also a U.S. Veteran
Yes, I am a U.S. Veteran
Yes, I am a U.S. Citizen EFM
No, I am neither a U.S. Citizen EFM, nor a U.S. Veteran
Have you invoked this preference for a prior position at this post/Mission?
Yes
No
If yes, which agency?
Date (mm-dd-yyyy)
If claiming eligibility for U.S. Veteran preference, you must attach a copy of your most recent DD-214, Certificate of Release or Discharge from
Active Duty. If claiming conditional eligibility for U.S. Veterans preference, you must submit proof of conditional eligibility.
EDUCATION
19. Graduate School
Dates Attended
Did you
Degree/Diploma
Major Subject
Name of School, City, State or Country
(mm-yyyy)
graduate?
From
Yes
To
No
Undergraduate College/University
Dates Attended
Did you
Degree/Diploma
Major Subject
Name of School, City, State or Country
(mm-yyyy)
graduate?
From
Yes
To
No
High School/GED or Country Equivalent
Dates Attended
Did you
If no, highest grade level completed.
Name of School, City, State or Country
(mm-yyyy)
graduate?
From
Yes
To
No
Other, e.g. Technical/Vocational School
Dates Attended
Did you
Certificate/Diploma
Major Subject
Name of School, City, State or Country
(mm-yyyy)
graduate?
From
Yes
To
No
DS-174
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