3. Vacancy Announcement Number 4. Date Available for Work ...

1 And/or 12b. Country Identification NumberMiddle Name14. If you are applying for a position that includes driving a Government vehicle, do you have a current and valid driver's license?If yes, Class/Type of License13. Are you legally eligible to work in this country?If yes, Mission HR may require verification of eligibility. Please attach copies of all documentation that confirms your legal eligibility to work in thiscountry ( , work permit, residency permit).12a. Social Security Number (for Citizens/Permanent Residents)If yes, provide Are you a Citizen?

2 6. Other Names UsedFirst Name8. Phone Department of StateAPPLICATION FOR EMPLOYMENT AS A LOCALLY EMPLOYED STAFF OR FAMILY MEMBER(This application is for positions recruited by the U. S. Mission under theOffice of Overseas Employment's Interagency Local Employment Recruitment Policy)POSITIONOMB APPROVAL NO. 1405-0189 EXPIRES: 5/31/2019 ESTIMATED BURDEN: 1 Hour1. Position Title2. Grade3. Vacancy Announcement Number 4. date Available for Work (mm-dd- yyyy )PERSONAL INFORMATION5. Last Name(s)/Surnames7. Current AddressDayEveningMobile9. E-mail AddressYesNoDS-174 05-2016 Page 1 of 611.

3 Do you have permanent Resident status (green card)? YesNoYesNo Yes No Not ApplicableIf yes, have you operated a vehicle without incident for the past three years? Yes No15. What days are you Available to work as part of a regularly scheduled work week? (Check all that apply.)Sunday16. Do any of your relatives or members of your household work for the United States Government?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 thedefinition of relatives and members of household.)

4 NameRelationshipAgency, Position, and CITIZEN ELIGIBLE FAMILY MEMBER (USEFM) AND VETERANS HIRING PREFERENCEEDUCATIONPage 2 of 618. Graduate School Name of School, City, State or CountryDates Attended(mm- yyyy )Did yougraduate?Degree/DiplomaMajor SubjectFromToNoYes Undergraduate College/University Name of School, City, State or CountryDates Attended(mm- yyyy )Did yougraduate?Degree/DiplomaMajor SubjectFromToNoYes High School/GED or Country Equivalent Name of School, City, State or CountryDates Attended(mm- yyyy )Did yougraduate?

5 If no, highest grade level Other, Technical/Vocational School Name of School, City, State or CountryDates Attended(mm- yyyy )Did yougraduate?FromToNoYesCertificate/Diplo maMajor SubjectMondayTuesdayWednesdayThursdayFri daySaturdayYesNo17. Are you claiming preference in hiring under law and policy based upon your status as either a Citizen Eligible Family Member (USEFM) or U. S. Veteran? See Instructions for Completing the DS-174 for additional information about the USEFM and Veterans hiring preference. (Check only one.) Citizen EFM and also a Citizen a Citizen EFM, nor a claiming eligibility for Veteran preference, you must attach a copy of your most recent DD-214, Certificate of Release or Discharge from ActiveDuty.

6 If claiming conditional eligibility for Veterans preference, you must submit proof of conditional you invoked this preference for a prior position at this post/Mission? YesNoIf yes, which agency? date (mm-dd-yyyyy)DS-174 05-2016 Salary per Year in Dollars or Local CurrencyFrom (mm- yyyy )20a. Job Title (If Government, include the series and grade)To (mm- yyyy )Hours per WeekEmployer's Name and AddressSupervisor's Name and Contact InformationNamePhone NumberE-mail AddressMay HR contact your supervisor?YesNoWere you a supervisor in this position?

7 YesNoIf yes, how many people did you supervise?Describe your major duties/responsibilities and accomplishments. Reason(s) for Leaving (Do not write "N/A" or "not applicable".) LANGUAGES19. List your languages, the appropriate competency levels, and your primary/first spoken/native language using the language standards below. Youmay only identify one primary/first spoken/native -Language Level To:SpeakReadWriteLanguage IndicatorsLevel IBasic KnowledgeLimited KnowledgeLevel IIGood Working KnowledgeLevel IIIF luentLevel IVProfessional Translator/InterpreterLevel VWORK EXPERIENCE20.

8 Include all work experience, paid and voluntary. Start with your present or most recent work experience. When describing work, list specificduties/responsibilities and accomplishments. Include supervisory responsibilities and the Number of employees supervised. Go into as much detail aspossible for work experience that directly relates to the advertised position. Include all periods of unemployment and the reason. (Use additionalpages, as needed.)20a. WORK EXPERIENCEPage 3 of 6DS-174 05-2016 Salary per Year in Dollars or Local CurrencyFrom (mm- yyyy )20b.

9 Job Title (If Government, include the series and grade)To (mm- yyyy )Hours per WeekEmployer's Name and AddressSupervisor's Name and Contact InformationNamePhone NumberE-mail AddressMay HR contact your supervisor?YesNoWere you a supervisor in this position?YesNoIf yes, how many people did you supervise?Describe your major duties/responsibilities and accomplishments. Reason(s) for Leaving (Do not write "N/A" or "not applicable".) 20b. WORK EXPERIENCES alary per Year in Dollars or Local CurrencyFrom (mm- yyyy )20c. Job Title (If Government, include the series and grade)To (mm- yyyy )Hours per WeekEmployer's Name and AddressSupervisor's Name and Contact InformationNamePhone NumberE-mail AddressMay HR contact your supervisor?

10 YesNoWere you a supervisor in this position?YesNoIf yes, how many people did you supervise?Describe your major duties/responsibilities and accomplishments. Reason(s) for Leaving (Do not write "N/A" or "not applicable".) 20c. WORK EXPERIENCEPage 4 of 6DS-174 05-2016 Page 5 of 6 Salary per Year in Dollars or Local CurrencyFrom (mm- yyyy )21d. Job Title (If Government, include the series and grade)To (mm- yyyy )Hours per WeekEmployer's Name and AddressSupervisor's Name and Contact InformationNamePhone NumberE-mail AddressMay HR contact your supervisor?