Form Ds-174 - Application For Employment As A Locally Employed Staff Or Family Member - U.s. Mission Page 11

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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
  
  
-    -    
-    -    
From
To
Local Currency
     
     
(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.
    
Reason(s) for leaving (Do not write “N/A” or 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
  
  
-    -    
-    -    
From
To
Local Currency
     
     
(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.
    
DS-174
Page ! 11
12-2009

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