Form Ds-174 - Application For Employment As A Locally Employed Staff Or Family Member - U.s. Mission Page 6
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12Describe your major duties/responsibilities and accomplishments.
Reason(s) for leaving (Do not write “N/A” or applicable)
25b. Job Title (If U.S. Government, include the Series and Grade)
Salary per Year in U.S. Dollars or 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.
Reason(s) for leaving (Do not write “N/A” or applicable)
25c. Job Title (If U.S. Government, include the Series and Grade)
Salary per Year in U.S. Dollars or 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
DS-174
Page ! 6
12-2009
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