Form Ds-174 - Application For Employment As A Locally Employed Staff Or Family Member - U.s. Mission

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OM
U.S. Mission
B
AP
PR
APPLICATION FOR EMPLOYMENT AS A 

OV
AL
LOCALLY EMPLOYED STAFF OR FAMILY MEMBER
NO
.
14
"
05-
01
(This application is for positions recruited by the U.S. Mission under the
89
Department of State’s Office of Overseas Employment’s interagency Local Employment Recruitment Policy)
EX
PI
RE
S:
12/
31/
20
12
ES
TI
MA
TE
D
BU
RD
EN
: 1
Ho
ur
POSITION
1. Position Title
2. Grades
     
     
3. Vacancy Announcement Number
4. Date Available for Work
(If known)
(mm-dd-
yyyy)
     
     
PERSONAL INFORMATION
5. Last Name(s) / Surnames
First Name
     
    
6. Other Names Used
    
7. Date of Birth
8. Place of Birth
(mm-dd-yyyy)
  
     
-    -    
9. Current Address
10. Phone Numbers
    
Day
     
     
Evening
     
Cell
11. E-mail Address
     
 
 
12. Are you a U.S. Citizen?
Yes
No
DS-174
Page ! 1
12-2009

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