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Ds 174application Form

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10.

Phone Numbers
U.S. Department of State
APPLICATION FOR EMPLOYMENT AS A
LOCALLY EMPLOYED STAFF OR FAMILY MEMBER
(This application is for positions recruited by the U. S. Mission under the
Office of Overseas Employment's Interagency Local Employment Recruitment Policy)
POSITION
OMB APPROVAL NO. 1405-0189
EXPIRES: 12/31/2012
ESTIMATED BURDEN: 1 Hour
1. Position Title 2. Grades
3. Vacancy Announcement Number (If known)
4. Date Available for Work
PERSONAL INFORMATION
Last Name(s)/Surnames First Name Middle Name 5.
6. Other Names Used
7. Date of Birth
(mm-dd-yyyy)
(mm-dd-yyyy)
8. Place of Birth
9. Current Address
Day
Evening
Cell
11. E-mail Address
12. Are you a U. S. Citizen?
Yes No
13. Do you have permanent U.S. Resident status?
Yes No
If yes, provide number
14a. U.S. Social Security Number (for U.S. Citizens/Permanent U.S. Residents)
14b. Country Identification Number
And/Or
15. Are you legally eligible to work in this country?
Yes
No
If yes, Mission HR may require verification of eligibility. Please attach copies of all documentation that confirms your legal
eligibility to work in this country (e.g., work permit, residency permit). If you are not sure if you need to submit proof of
eligibility, contact the Mission's HR office.
16. If hired, are there accommodations the Mission needs to provide so that you can perform all the essential functions
and duties of the position? Yes
No If yes, please explain
17. If you are applying for a position that includes driving a U.S. Government vehicle, do you have a valid drivers license?
Yes No
If yes, Class/Type of License
If yes, have you operated a vehicle without incident for the past three years?
Yes No
DS-174
12-2009
Page 1 of 7
20. 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)
Other, e.g Technical/Vocational School
Name of School, City, State
or Country
18. 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
19. 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
Yes, I am a U.S. Citizen EFM
Yes, I am a U.S. Veteran
Yes, I am a U.S. Citizen EFM and also a U.S. Veteran
No, I am neither a U.S. Citizen, nor a U.S. Veteran
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
Page 2 of 7
21. Graduate School
Name of School, City, State
or Country
Dates Attended Graduate? Degree/Diploma Major Subject
(mm-dd-yyyy)
From
To
Yes
No
Undergraduate College/University
Name of School, City, State
or Country
High School/GED or Country
Equivalent
Name of School, City, State
or Country
Dates Attended
(mm-dd-yyyy)
From
To
Graduate?
Yes
No
Degree/Diploma Major Subject
Graduate? Dates Attended
(mm-dd-yyyy)
If no, highest grade level completed
From
To
Yes
No
Dates Attended
(mm-dd-yyyy)
Graduate? Certificate/
Diploma
Major Subject
From
To
Yes
No
DS-174
LANGUAGES
LICENSE, SKILLS, TRAINING, MEMBERSHIP, AND RECOGNITION
Employer's Name and Address
22. List professional licenses, certifications, typing/keyboard, computer skills, formal and on-line training, and other skills
and abilities you consider relevant to the position. Please include the license or certification number. Attach a copy if
the license or certification is a requirement of the position. If licensed in the U.S., please list the state of issuance. If
licensed in another country, please list the province/state/region and country of issuance. (Use additional pages, as
required)
23. List professional organizations, associations, awards, honors, fellowships, and publications you consider significant.
24. 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 Speak Read Write Primary Language?
Yes No
Yes No
Yes No
Yes No
WORK EXPERIENCE
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 required)
25a. Job Title (If U.S. Government, include the Series and Grade)
(mm-dd-yyyy)
From To
(mm-dd-yyyy)
Salary per Year in U.S. Dollars or
Local Currency
Hours per Week
Supervisor's Name and Contact Information
May HR contact your current supervisor?
Yes
No
Name
Phone Number
E-mail Address
Page 3 of 7
LICENSE, SKILLS, TRAINING, MEMBERSHIP, AND RECOGNITION
DS-174
Supervisor's Name and Contact Information
Describe your major duties/responsibilities and accomplishments.
Reason(s) for leaving. (Do not write "N/A" or Not applicable)
25b. Job Title (If U.S. Government, include the series and grade)
From
(mm-dd-yyyy)
To
(mm-dd-yyyy)
Salary per Year in U.S. Dollars or
Local Currency
Hours per Week
Employer's Name and Address
Name
Phone Number
E-mail Address
Describe your major duties/responsibilities and accomplishments.
Reason(s) for leaving. (Do not write "N/A" or Not applicable)
25c. Job Title (If U.S. Government, include the Series and Grade)
Salary per Year in U.S. Dollars or
Local Currency
Hours per Week
From
(mm-dd-yyyy)
To
(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 Not Applicable)
Page 4 of 7 DS-174
25d. Job Title (If U.S. Government, include the Series and Grade)
From
(mm-dd-yyyy)
To
(mm-dd-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
Describe your major duties/responsibilities and accomplishments.
Reason(s) for leaving. (Do not Write "N/A" or Not Applicable)
REFERENCES
26. List three personal references who are not relatives or former supervisors who have knowledge of your work performance.
Mission HR will obtain your permission before contacting any reference.
Name Telephone Occupation Address
SIGNATURE AND CERTIFICATION
27. I certify that, to the best of my knowledge and belief, all of the information on and attached to this application is true,
correct, complete, and made in good faith. I understand that false or fraudulent information on or attached to this application
may be grounds for not hiring me, or for termination/dismissal after I begin work, and may be punishable by fine or
imprisonment according to this country's law or U.S. law. I understand that any information I voluntarily provide on or attached
to this application may be investigated.
Signature (mm-dd-yyyy) Date
Page 5 of 7 DS-174
PRIVACY ACT STATEMENT
(for U.S. Citizens and Legal Permanent Residents of the U. S.)
The information is sought pursuant to, e.g., the Foreign Service Act of 1980, as amended, and
AUTHORITIES:
22 U.S.C. 2669(c)
PURPOSE: The information solicited on this form is necessary to establish your eligibility and qualifications for
advertised positions. The information furnished may also be used in the pre-employment fitness-for-duty process, if
you are selected for a Mission position. We are authorized to solicit your social security number (SSN) by Executive
Order 9397 to confirm the identity and employment eligibility of the individual. The SSN may also be used to seek
information about you from employers, schools, banks, and others who know you. Disclosure of this information,
including your social security number, is voluntary. Failure to provide the information requested on this application
may result in delays in considering your application. It could result in you not receiving full consideration for the
position. Incomplete addresses slow processing of your application.
ROUTINE USES: The information you provide in this form may be shared with Federal, State, local, and foreign
agencies to the extent relevant and necessary for that agency's decision about you. This information may be
disclosed to a member of Congress or to a congressional staff member in response to an inquiry of the
Congressional office made at the written request of the constituent etc. This information may be disclosed to a
member of Congress or to a congressional staff member in response to an inquiry of the Congressional office
made at written request of the constituent about whom the record is maintained. Information may also be
disclosed in the course of presenting evidence to a court, magistrate, or administrative tribunal, including
disclosures to opposing counsel in the course of settlement negotiations.
response, including time required for searching existing data sources, gathering the necessary documentation,
providing the information and/or documents required, and reviewing the final collection. You do not have to
supply this information unless this collection displays a currently valid OMB control number. If you have
comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to:
A/GIS/DIR, Room 2400 SA-22, U.S. Department of State, Washington, DC 20522-2202
BURDEN: Public reporting burden for this collection of information is estimated to average 60 minutes per
EQUAL OPPORTUNITY STATEMENT
The United States Government is an equal opportunity employer.
Page 6 of 7 DS-174
25_ Job Title (If U.S. Government, include the Series and Grade)
Describe your duties/responsibilities and accomplishments
Reason(s) for leaving
DS-174 CONTINUATION SHEET - WORK EXPERIENCE
Salary per Year in U.S. Dollars or
Local Currency
Hours per Week
From
(mm-dd-yyyy)
To
(mm-dd-yyyy)
Supervisor's Name and Contact Information Employer's Name and Address
Name
Phone Number
E-mail Address
Describe your duties/responsibilities and accomplishments.
Describe your reason(s) for leaving. (Do not write "N/A" or Not Applicable)
Phone Number
E-mail Address
Describe your duties/responsibilities and accomplishments
Reason(s) for leaving
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
Local Currency
Hours per Week
From
(mm-dd-yyyy)
To
(mm-dd-yyyy)
Supervisor's Name and Contact Information Employer's Name and Address
Name
Phone Number
E-mail Address
Describe your major duties/responsibilities and accomplishments.
Describe your reason(s) for leaving. (Do not write "N/A" or Not Applicable)
Page 7 of 7 DS-174
INFORMATION ABOUT MISSION EMPLOYMENT AND INSTRUCTIONS FOR COMPLETING THE DS-174,
APPLICATION FOR EMPLOYMENT AS A LOCALLY EMPLOYED STAFF OR FAMILY MEMBER
IMPORTANT INFORMATION ABOUT MISSION EMPLOYMENT AND APPLYING
FOR MISSION POSITIONS
Instruction Page 1 of 8 DS-174
12-2009
1. You must apply for Mission positions using the DS-174, or a resume that provides all the information on the
DS-174. If you submit only a resume and it does not provide all the information requested on the DS-174, Mission
HR has the authority to require that you complete a DS-174 at some point during your candidacy. Failure to provide
all the information requested on the DS-174 either by completing the DS-174, or submitting a resume that contains
all the information on the DS-174, means you may lose consideration for the position.
2. Make sure you are eligible to apply. For example, the Mission sometimes restricts recruitment to current Mission
employees.
3. The Mission Human Resources office must receive your application package by the closing date on the Vacancy
Announcement. Otherwise, you lose consideration for the position.
4. Providing your U.S. Social Security Number (for U.S. Citizens and Legal Permanent Residents of the U.S.), or
country identification number (for everyone else), as well as all other personal information, is voluntary. However,
Mission HR is unable to process your application if you do not voluntarily provide the information requested in the
DS-174.
5. Under U.S. Law including the Foreign Service Act of 1980, as amended, U.S. Citizen Eligible Family Members (3
FAM 7120) and U.S. Veterans receive a preference in hiring, subject to Mission HR confirmation of eligibility.
6. Positions staffed by the U.S. Mission require that U.S. citizen males over age 18 and born after December 31,
1959, register with the United States Selective Service System, or have an exemption from the U.S. Office of
Personnel Management (OPM).
7. U.S. law and regulation do not allow U.S. Government employees to appoint, hire, promote, or recommend their
relatives or Members of Household for employment at the Mission.
8. Federal civilian annuitants may have their salaries or annuities reduced if employed by the Mission.
GENERAL INFORMATION AND
INSTRUCTIONS FOR COMPLETING THE DS-174
1. Type or print clearly in ink. Mission HR does not consider application packages submitted in pencil.
2. You may complete the application in English or your primary/first spoken/native language. However, if the Vacancy
Announcement states that all candidates for employment must submit their applications in English, then you must
submit the application in English.
3. If you need more space for an answer, use an additional sheet of paper. In the top right corner of each sheet, write
your complete name, the position title, and the Vacancy Announcement Number (if you know it).
4. Answer all questions on the DS-174 that apply to you fully and in detail. If you do not answer all questions fully and
in detail, you may delay the Human Resources review of your application and you may lose consideration for the
position. If a question on the DS-174 does not apply to you, then write "N/A" (Not Applicable) in the box or space
provided.
5. Attach copies of all documentation you believe is relevant to the position, your eligibility, and your qualifications to
the DS-174. DO NOT ATTACH THE ORIGINAL. This includes eligibility documentation such as a copy of your work
permit or residency permit. It also includes qualifications documentation such as copies of certificates of training,
licenses, proficiencies, publications, and educational transcripts. If you are not sure what documentation you must
submit, contact the Mission HR office.
Instruction Page 2 of 8
Block 2.
Block 3.
INSTRUCTIONS FOR COMPLETION
Block 1. Position Title: Provide the position title stated on the Vacancy Announcement or media advertisement.
Block 4:
POSITION
DS-174
Date Available for Work: Provide the date you are available to start working, if you are offered the position.
Example: June 1, 20XX.
Vacancy Announcement Number: Provide the Vacancy Announcement Number, if you know it.
If you don't, write "N/A."
Grades: Provide the grade of the position (FSN and FP), if you know it.
Example: FSN-8; FP-6. If you don't know the grades of the position, write "N/A."
Block 5.
Block 6.
Block 7.
Block 8.
Block 9.
Block 10.
Block 11.
Block 12.
Block 13
Block 14A/14B.
Block 15
Block 16.
Block 17.
Last Name(s)/Surname: Provide your last name or surname.
First Name: Provide your first or given name
Middle Name: Provide your middle name
Other Names Used: List all the other names, including nicknames, you use or have used in the past
that are not in Block 5.
Date of Birth: Provide your date of birth using the mm-dd-yyyy format. Example: 11-12-1986.
Place of Birth: If you were born in the United States, provide the city, state and country.
Example: Winston-Salem, North Carolina, USA. If you were born outside of the United States,
provide the city, province/region/state/department, and country. Example: Asuncion, Central
Department, Paraguay.
Current Address: Provide your complete current address, including apartment number, building
number, and other residential identifiers.
Phone Numbers: Provide your daytime, evening, and cellular contact numbers, including country,
regional, area, or city codes, as appropriate.
E-mail Address: Provide your E-mail address. Example: JaneDoe123@hotmail.com. If you don't
have an E-mail address, write "N/A."
U. S. Citizenship: Check the appropriate box.
Permanent U. S. Resident Status: Check the appropriate box. If you check yes, provide your
permanent resident status number.
U. S. Social Security Number and/or Country Identification Number: Provide your U.S. Social
Security Number or your Country Identification Number. If you have both a U.S. Social Security
Number and a Country Identification Number, provide both numbers.
Confirmation of Eligibility: Certify that you are legally eligible for employment in the country where
the Mission is located by checking the appropriate box. Attach copies of the required paperwork
(e.g. work permit, residency permit), if appropriate. Do not attach originals. If you are not sure you
need to submit proof of eligibility paperwork, or what paperwork you need to submit, contact the
Mission HR office.
Accommodations: Check the appropriate box and provide explanatory information, as appropriate.
Drivers License: Answer this question only if the position you are applying for requires driving a U.S.
Government vehicle. List the type of License you have. Example A: None; Example B: Class A, to
drive any tractor-trailer or combination of motor vehicle and towed vehicle where the towed vehicle
exceeds a gross weight of 4,600 kilograms. Attach a copy of your current license to the application.
Check "Yes" or "No" to indicate whether you have driven without incident within the last three years.
Instruction Page 3 of 8
PERSONAL INFORMATION
DS-174
Block 18.
Block 19.
Block 20.
U.S. Citizen Eligible Family Members (USEFM): For purposes of receiving a preference in hiring for a qualified
position, a USEFM is an individual who meets the following criteria:
Other family members or dependents on direct-hire Foreign Service, Civil Service, or uniformed services
member's travel orders are not USEFMs or AEFMs for purposes of 3 FAM 8200.
If you claim status as a U.S. Citizen EFM, Mission HR may need to verify your status and eligibility. Mission HR's
decision on eligibility for the preference as a USEFM is final.
U.S. CITIZEN ELIGIBLE FAMILY MEMBER AND U.S. VETERANS HIRING PREFERENCE
Instruction Page 4 of 8 DS-174
Availability: Check all the days you are available to work as part of a regularly scheduled work week.
A regularly scheduled work week is the official work week set by the supervisor based upon the
assigned duties and responsibilities of the position. Following are three examples of regularly
scheduled work weeks:
a. Monday through Friday, 8:00 a.m. until 5:00 p.m.
b. Monday through Thursday, 8:00 a.m. until 12:00 p.m. and Friday, 8:00 a.m. until 5:00 p.m.
c. Saturday through Wednesday, 7:30 a.m. until 4:30 p.m.
Relatives: Check the appropriate box. If you check "Yes," then list all relatives or members of your
household who currently work for the U.S. Government . Relatives and members of household
include father, mother, husband, wife, unmarried partner of the opposite or same sex, son, daughter,
brother, sister, uncle, aunt, first cousin, nephew, niece, father-in-law, mother-in-law, son-in-law,
daughter-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson, stepdaughter,
stepbrother, stepsister, half brother, and half sister.
Preference in Hiring: Check the appropriate box: You may only check one box.
1. U.S. citizen; and
2. The spouse or domestic partner of the sponsoring employee, or a child of the sponsoring
employee who is unmarried and at least 18 years old; and
3. Listed on the travel orders of a sponsoring employee, i.e., a direct-hire Foreign Service, Civil
Service, or uniformed service member who is permanently assigned to or stationed abroad at a U.S.
mission, or at an office of the American Institute in Taiwan, and who is under Chief of Mission
authority, and either:
a. Resides at the sponsoring employee's post of assignment abroad or, as appropriate, at an
office of the American Institute in Taiwan; or
b. Resides at an involuntary separate maintenance allowance (ISMA) location, authorized
under 3 FAM 3232.2. If residing at an ISMA location, the individual will not be listed on the
sponsoring officer's travel orders but will have a form SF-1190 processed authorizing ISMA.
U.S. Veterans
Block 21.
EDUCATION
Instruction Page 5 of 8
DS-174
a. If you claim status as a U.S. Veteran, you must attach a copy of your DD-214, Certificate of Release or
Discharge from Active Duty. Failure to provide a copy of your DD-214 to Mission HR by the closing date of
the Vacancy Announcement means you lose eligibility for the hiring preference.
b. If you claim conditional preference status as a U.S. Veteran, you must attach proof of eligibility to your
application. Examples include a copy of your current military orders, or a letter on official military letterhead
signed by the commanding officer that states the type of service and that you are in an active duty status.
Failure to provide proof of conditional eligibility to Mission HR by the closing date of the Vacancy
Announcement means you lose eligibility for a conditional preference in hiring.
Mission HR's decision on eligibility for U.S. Veterans preference after reviewing the DD-214, or conditional
eligibility documentation, is final.
The Local Employment Recruitment policy does not use points in applying the hiring preference for USEFM
or U.S. Veteran candidates. Under U.S. law including the Foreign Service Act of 1980, as amended,
status as a USEFM or U.S. Veteran is an affirmative factor in employment. To receive a preference in
hiring, USEFM and U.S. Veteran candidates must be fully qualified before receiving first consideration for
the advertised position.
USEFM and U.S. Veteran candidates generally have an equal preference in hiring; however, a U.S. Citizen
EFM who is also a U.S. Veteran receives preference in hiring before all other preference candidates.
Under the Local Employment Recruitment policy, USEFM and U.S. Veteran candidates are eligible to
receive the preference each time they apply for Mission-advertised positions, subject to Mission HR
confirmation of eligibility. Application of the preference is not restricted to the candidate's initial hiring at the
U.S. Mission.
a. School: If you have graduate studies beyond a Bachelors degree or host country equivalent, start in the
first block, "Graduate School." If you have college/university studies, start in next block down,
"Undergraduate/ College University." If you did not attend college/university, start with the "High
School/General Educational Development (GED)" box. (The GED tests are a group of five tests which
when passed, certifies that the taker has American or Canadian high school-level academic skills.) Use the
Technical/Vocational school box for all other formal education. List the name of the school, city and state.
Example: Clemson University, Clemson, South Carolina, USA

b. Dates Attended: List the dates using the mm-dd-yyyy format. Example: 08-02-2000.
c. Graduate: Check either "Yes" or "No."
d. Degree/Diploma and Major Subject:
If you are a college/university or technical school graduate, indicate your degree field under
"Degree/Diploma." If you double majored in school, list your major and minor fields of study under "Major
Subject."
Example: Major: Economics; Minor: Sports Medicine.
If you have university studies but did not graduate, check "No" in the "Graduate" box, write "N/A" in the
"Degree/Diploma" box, and write "General course work" in the "Major Subject" box.
If you have graduate studies but did not graduate, check "No" in the "Graduate" box, write "N/A" in the
"Degree/Diploma" box and write the area of graduate work you were pursuing in the "Major Subject" box.
Example: "Psychology."
If you have technical school, vocational school, or other formal school education but did not graduate, check
"No" in the "Graduate" box, write "N/A" in the "Degree/Diploma" box, and write the main technical or vocational
course work you took. Example: Welding
Block 22.
Block 23.
Block 24.
Include keyboard, computer, professional licenses/certifications, formal and on-line training, and
other skills and abilities you have that directly relate to the position you're applying for, or that you
consider relevant to your candidacy.
If a license or certification is a requirement of the position (e.g., electrician certification, Registered
Professional Nurse), then you must attach a copy to your application. Do not attach the original
license or certification. If you do not attach a copy to your application, you may lose consideration for
the position.
If a license or certification is not a requirement of the position, you may attach copies of
licenses/certifications to your application that you believe are relevant to or strengthen your
candidacy. Do not attach the original license or certification. Mission HR has the authority to require
proof of anything you include as part of your application package in Block 22.
List professional organizations, associations, awards, honors, fellowships, and publications you have
that directly relate to the position you're applying for, or that you consider relevant to or strengthen
your candidacy. Mission HR has the authority to require proof of honors, publications, or anything
else you list in Block 23.
The Mission assesses language proficiency using the following standards:
You must list your language proficiency using the Level I-V standard. You must identify one and only
one language as your primary/first spoken/native language. If you are bilingual or multi-lingual, you
may only choose one language as your primary/first spoken/native language. If you are not
proficient in all three components of the language (speaking, reading, and writing), then list your
proficiency in the components that apply and write "N/A" in the components that do not apply.
LICENSE, SKILLS, TRAINING, MEMBERSHIP, AND RECOGNITION
LANGUAGES
Language
Speak Read Write Primary Language?
Spanish
English
Italian
Arabic
IV
IV
II
I
IV
IV
II
N/A
IV
IV
I
N/A
Yes
Instruction Page 6 of 8
DS-174
Level I = Basic Knowledge
Level II = Limited Knowledge
Level III = Good Working Knowledge
Level IV = Fluent
Level V = Professional Translator/Interpreter
Following is an example of how to complete Block 24:
Human Resources may require testing in one or all languages you include in your application.
Block 25.
WORK EXPERIENCE
Instruction Page 7 of 8 DS-174
Work experience includes all paid and volunteer work, including internships, fellowships, and grants.
Include all of your work experience. List your current or most recent paid or volunteer work first in
Block 25a and work backwards. Include all periods of unemployment and the reason for the
unemployment. Use additional pages, if needed.
a. Job Title: Use official job titles only. If you have work experience with the U.S.Government,
include the job title, series (if you know it), and the grade.
Example 1: Voucher Examiner, Series 420, Grade 7
Example 2: Biology Teacher, Pay Band 6
b. Dates of Employment: Provide the dates of employment using the mm-dd-yyyy format.
Example: From: 08-30-2000 To: 09-01-2008
c. Salary: Make sure you provide your annual salary, not weekly or monthly salary. You may
provide salary in either U.S. dollars or the local currency of the Mission where you are applying. If
you have a salary history that is not denominated in U.S. dollars or the local currency of the Mission
where you are applying, convert the salary to U.S. dollars and provide it on the application.
d. Hours per week: Provide the hours of your regularly scheduled workweek. Example: 20
e. Employer's Name and Address: Provide your employer's complete name and address and
indicate if Mission HR may contact your current supervisor.
f. Supervisor's Name and Contact: Provide the name and contact information of your supervisor. If
you do not know your supervisor's E-mail address, put "N/A."
g. Duties/Responsibilities and Accomplishments: It's your responsibility to demonstrate that you are
qualified for the position. Read the advertised position requirements (e.g., prior work experience,
computer skills, customer service work) on the Vacancy Announcement or media advertisement.
Then describe your duties/responsibilities and accomplishments in the position in as much detail as
possible. Make sure you include all formal and informal supervisory responsibilities. Indicate the
percentage of time you spent performing for each major duty and responsibility, e.g., 20 percent.
Use additional pages, if needed.
If you had a major change of duties and responsibilities while you worked for the same employer,
then describe each role as a separate job, i.e., Complete Block 25a, then Block 25b.
h. Reason for Leaving: Always state the reason you left your previous employment. If you are
currently employed, then put "currently employed" in the "Reason for Leaving" box. You may not put
"N/A" for "Not Applicable" as the reason for leaving. If you were terminated, or voluntarily or
involuntarily separated, then state why in specific terms.
Example: "I was involuntarily separated because of a Reduction-In-Force in my division."
The U.S. Mission provides equal opportunity and fair and equitable treatment in employment to all people
without regard to race, color, religion, sex, national origin, age, disability, political affiliation, marital status,
protected genetic information, or sexual orientation.
The EEO complaint procedure is not available to individuals who believe they have been denied equal
opportunity based upon marital status or political affiliation. Individuals with such complaints should avail
themselves of the appropriate grievance procedures, remedies for prohibited personnel practices, and/or
courts for relief."
REFERENCES
List three personal references. Ideally they are individuals who know you professionally and can
comment on your suitability for employment at the Mission. Personal references may not be
relatives, members of your household, or your former supervisors. You may wish to inform
personal references that you are including their names and contact information in your application
since Mission HR may contact personal references.
It is your responsibility to sign and date your application in ink. If you do not sign and date the
application, or if you sign and date the application in pencil, then you lose consideration for the
position. Your signature in ink certifies that the information on and attached to your application is
true, correct, complete, and made in good faith. Including false information on and attached to
your application is fraud. It is grounds for not hiring you, or for terminating you after you begin to
work. Signing the application also confirms that you understand that the Mission may investigate
any information you voluntarily submit.
SIGNATURE AND CERTIFICATION
DS-174 CONTINUATION SHEET
Use the DS-174 Continuation Sheet to list your complete work experience. Use as many of the DS-174
Continuation Sheets as you need. Start at the top of the DS-174 Continuation Sheet with 25E and proceed
through the alphabet until you provide your complete work history. Use the instructions for completing Block
25 to complete the DS-174 Continuation Sheet.
EQUAL OPPORTUNITY EMPLOYER
Instruction Page 8 of 8 DS-174
Block 26.
Block 27.

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