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
1. Position Title / 2. Grade
3. Vacancy Announcement Number / 4. Date Available for Work (mm-dd-yyyy)
PERSONAL INFORMATION
5. Last Name(s)/Surnames / First Name / Middle Name
6. Other Names Used
7. Current Address / 8. Phone Numbers
Day
Evening
Mobile /


9. E-mail Address
10. Are you a U.S. Citizen?
Yes No
11. Do you have permanent U.S. Resident Status(green card)? Yes No
If yes, provide number.
12a. U.S. Social Security Number (for U.S. Citizens/Permanent U.S. Residents)
and/or
12b. Country Identification Number
13. 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).
14. If you are applying for a position that includes driving a U.S. Government vehicle, do you have a current and valid driver’s license?
Yes No Not Applicable
If Yes, Class/Type of License

If Yes, have you operated a vehicle without incident for the past three years?
Yes No
15. 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
16. 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
17. Are you claiming preference in hiring under U.S. law and policybased 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)
U.S. Citizen EFM
U.S. Citizen EFM and also a U.S. Veteran / U.S. Veteran.
Neither a U.S. Citizen EFM, nor a U.S. Veteran.
Have you invoked this preference for a prior position at this post/Mission? Yes No
If yes, which agency? Date (mm-dd-yyyy

If claiming eligibility for US 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
18. Post Graduate School
Name of School,
City, State or Country / Dates Attended
(mm-yyyy)
From

To / Did you Graduate?
Yes
No / Degree/Diploma / Major Subject
Graduate School
Name of School,
City, State or Country / Dates Attended
(mm-yyyy)
From

To / Did you Graduate?
Yes
No / Degree/Diploma / Major Subject
Graduate School
Name of School,
City, State or Country / Dates Attended
(mm-yyyy)
From

To / Did you Graduate?
Yes
No / Degree/Diploma / Major Subject
Undergraduate College/University
Name of School,
City, State or Country / Dates Attended
(mm-yyyy)
From

To / Did you Graduate?
Yes
No / Degree/Diploma / Major Subject
Undergraduate College/University
Name of School,
City, State or Country / Dates Attended
(mm-yyyy)
From

To / Did you Graduate?
Yes
No / Degree/Diploma / Major Subject
High School/GED or Country Equivalent
Name of School,
City, State or Country / Dates Attended
(mm-yyyy)
From

To / Did you Graduate?
Yes
No / If no, highest grade level completed
Other, e.g. Technical/Vocational School
Name of School, City, State or Country / Dates Attended
(mm-yyyy)
From

To / Did you Graduate?
Yes
No / Certificate/Diploma / Major Subject
LANGUAGES
19. 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
Language Level To: / Speak / Read / Write
Primary -
WORK EXPERIENCE
20. 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 needed.)
20a. WORK EXPERIENCE
20a. Job Title (If U.S. Government, include the series and grade)
From (mm-yyyy) / To (mm-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
Were you a supervisor in this position? Yes No
If yes, how many people did you supervise? / May HR contact your supervisor?
Yes No
Describe your major duties/responsibilities and accomplishments.
Reason(s) for leaving (Do not write “N/A” or “not applicable”.)
20b. WORK EXPERIENCE
20b. Job Title (If U.S. Government, include the series and grade)
From (mm-yyyy) / To (mm-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
Were you a supervisor in this position? Yes No
If yes, how many people did you supervise? / May HR contact your supervisor?
Yes No
Describe your major duties/responsibilities and accomplishments.
Reason(s) for leaving (Do not write “N/A” or “not applicable”.)
20c. WORK EXPERIENCE
20c. Job Title (If U.S. Government, include the series and grade)
From (mm-yyyy) / To (mm-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
Were you a supervisor in this position? Yes No
If yes, how many people did you supervise? / May HR contact your supervisor?
Yes No
Describe your major duties/responsibilities and accomplishments.
Reason(s) for leaving (Do not write “N/A” or “not applicable”.)
20d. WORK EXPERIENCE
20d. Job Title (If U.S. Government, include the series and grade)
From (mm-yyyy) / To (mm-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
Were you a supervisor in this position? Yes No
If yes, how many people did you supervise?
/ May HR contact your supervisor?
Yes No
Describe your major duties/responsibilities and accomplishments.
Reason(s) for leaving. (Do not write “N/A” or “not applicable”)
LICENSE, SKILLS, TRAINING, MEMBERSHIP, AND RECOGNITION
21. List professional licenses, certifications, typing/keyboard skills, computer skills, formal and online training, and other skills and abilities you consider relevant to the position. Include the license or certification number and 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 necessary.)
22. List professional organizations, associations, awards, honors, fellowships and publications you consider significant.
REFERENCES
23. List three personal references who are not relatives or former supervisors who can speak knowledgeably of your work performance.
Name / Address / Telephone / Occupation
SIGNATURE AND CERTIFICATION
24. 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: / Date (mm-dd-yyyy)
CONTINUATION - WORK EXPERIENCE
20_. Job Title (If U.S. Government, include the series and grade)
From (mm-yyyy) / To (mm-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
Were you a supervisor in this position? Yes No
If yes, how many people did you supervise? / May HR contact your supervisor?
Yes No
Describe your major duties/responsibilities and accomplishments.
Reason(s) for leaving. (Do not write “N/A” or “not applicable”)
CONTINUATION - WORK EXPERIENCE
20_. Job Title (If U.S. Government, include the series and grade)
From (mm/yyyy) / To (mm/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
Were you a supervisor in this position? Yes No
If yes, how many people did you supervise? / May HR contact your supervisor?
Yes No
Describe your major duties/responsibilities and accomplishments.
Reason(s) for leaving. (Do not write “N/A” or “not applicable”.)

DS-174 Page 1 of 7

05-2016

INFORMATIONABOUTMISSIONEMPLOYMENTAND INSTRUCTIONS FORCOMPLETINGTHE DS-174,APPLICATIONFOR EMPLOYMENTAS A LOCALLYEMPLOYED STAFFORFAMILY MEMBER
IMPORTANT INFORMATION ABOUT MISSION EMPLOYMENTAND APPLYING FOR MISSION POSITIONS
1.You mustapply for Missionpositionsusing the DS-174.
2.Make sureyou are eligible to apply.For example, the Missionsometimesrestrictsrecruitmentto current Mission employees.
3.TheMission HumanResourcesofficemustreceive your application package by the closing date on the Vacancy Announcement.Otherwise, youlose consideration forthe position.
4.Providing your U.S.Social Security Number(for U.S. CitizensandLegal PermanentResidentsofthe U.S.),orcountry identification number(foreveryone else), as well asallotherpersonalinformation,is voluntary.However,MissionHRisunableto process your application ifyou do notvoluntarilyprovidethe information requested in the DS-174.
5.Under U.S.lawandpolicy,U.S.Citizen Eligible FamilyMembersand U.S.Veterans receivea preference inhiring,subject to Mission HRconfirmation ofeligibility.
6.Positionsstaffed by theU.S.Missionrequire thatU.S.citizen males overage 18 and born after December 31,1959,register withthe United StatesSelective Service System,or have an exemption fromthe U.S. Office ofPersonnel Management(OPM).
7.U.S.lawand regulation do notallowU.S.Governmentemployees toappoint,hire,promote, or recommend their relatives or Members ofHousehold for employmentat theMission.
8.Federalcivilianannuitantsmayhave their salaries or annuitiesreduced ifemployed by the Mission.
INSTRUCTIONS FOR COMPLETINGTHE DS-174
1.Typeorprintclearlyinink.MissionHR doesnotconsider application packagessubmitted inpencil.
2.Youmay complete theapplicationinEnglishoryourprimary/firstspoken/native language.However, ifthe Vacancy Announcement states thatallcandidates foremploymentmustsubmittheirapplicationsinEnglish,thenyou must submit theapplicationinEnglish.
3.Ifyou need more space for an answer,attach an additional sheetof paper.In the top rightcorner of each sheet, include your complete name, theposition title, and theVacancy AnnouncementNumber.
4.Answer all questions on the DS-174that apply to you fully and in detail.Ifyou do notanswer allquestions fully and in detail,youmay delaytheHuman Resources reviewofyour application and you maylose consideration for the position.Ifa question on the DS-174 does notapply to you,then write "N/A"(Not Applicable) in the boxor space provided.
5.Attach copiesofalldocumentationyoubelieveisrelevanttothe position,your eligibility,and your qualificationsto theDS-174.Thisincludeseligibilitydocumentationsuch asa copyofyourworkpermitorresidencypermit.It also includes qualifications documentationsuch ascopies ofcertificatesoftraining, licenses, proficiencies, publications,andeducationaltranscripts.Ifyou are notsure what documentationyou mustsubmit,contactthe Mission HR office. DO NOT ATTACH ORIGINAL DOCUMENTS.
INSTRUCTIONSFORCOMPLETION
POSITION
Block1.PositionTitle -Providetheposition title stated onthe Vacancy Announcementormediaadvertisement.
Block2.Grade -Provide the grade ofthe position(FSN and FP/FS).Example:FSN-8;FP/FS-6.
Block3.VacancyAnnouncement Number-ProvidetheVacancyAnnouncementNumber.
Block4.Date Available forWork-Providethe date you are available to startworking,ifyou are offered the position.(Example:06-01-2012.)
Block5.Last Name(s)/Surname-Provide your last name or surname.
First Name- Provide your firstor given name.
MiddleName-Provide yourmiddlename.
Block6.Other Names Used -Listalltheothernames,includingnicknames,youuseorhaveusedin thepast thatare notin Block5.
Block7.CurrentAddress -Provide your completecurrentaddress, including apartment number, building number,mailing code, and otherresidential identifiers.
Block8. Phone Numbers - Provideyour daytime, evening,and mobile numbers,including country,regional, area, or citycodes, as appropriate.
Block9. E-mailAddress -Provide youre-mailaddress.(Example:.) Ifyou don'thave an e-mail address, write "N/A."
Block10. U.S.Citizenship -Checkthe appropriate box.
Block11. Permanent U.S. Resident Status - Check theappropriate box. If youcheckyes,provide your permanentresidentstatus number.
Block12. 12a.U.S. SocialSecurityNumber and/or12b.CountryIdentification Number-Provide your U.S.Social SecurityNumberoryourCountryIdentificationNumber.If you have both a U.S.SocialSecurity Number and a Country Identification Number, provide bothnumbers.
Block 13. 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 the original documents. 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.
Block15. Driver’s License -Answer thisquestion only ifthe positionyou are applyingfor requiresdriving a U.S. Governmentvehicle.Listthe type ofLicense you have.(ExampleA: ClassA,todrive any tractor-trailer or combination ofmotorvehicle andtowed vehicle where the towedvehicle exceedsa gross weightof 4,600 kilograms.)Attach a copyof your currentlicense tothe application. Check "Yes" or"No" to indicatewhetheryou have driven withoutincidentwithin thelast three years.
Block16. Availability-Checkallthedaysyouareavailableto workaspartofaregularlyscheduledworkweek. A regularly scheduled workweek isthe official workweeksetbythe supervisor based upon the assignedduties and responsibilities ofthe position.Following arethreeexamples of regularly scheduled workweeks:
  1. Monday through Friday,8:00 a.m.until 5:00 p.m.
  2. Monday through Thursday,8:00 a.m.until 12:00 p.m. and Friday,8:00 a.m.until 5:00p.m.
  3. Saturdaythrough Wednesday,7:30 a.m.until 4:30 p.m.
Block17. Relatives -Checkthe appropriate box.Ifyou check "Yes," then listall relatives or members ofyour householdwho currently work for the U.S.Government.Relatives and membersofhouseholdincludefather, mother,husband,wife, unmarried partner ofthe opposite or samesex,son, daughter,brother,sister, uncle,aunt, firstcousin, 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,regardlessof whether these individualssharea residence with you,as well asany other individuals who reside withyou in U.S. Government housingotherthan legitimate domestic staff.
U.S. CITIZEN ELIGIBLE FAMILYMEMBERANDU.S.VETERANSHIRINGPREFERENCE
Block18. Preference in Hiring -Check theappropriate box. You mayonly check one box.
U.S.CitizenEligibleFamilyMembers (USEFM) -For purposes ofreceiving a preference inhiringfor a qualifiedposition,a USEFMisanindividualwho meets thefollowing criteria:
1.U.S.citizen;and
2.The spouse or domestic partner of the sponsoringemployee,or a child ofthe sponsoring employeewho is unmarried and atleast18years old; and
3.Listed on the travel orders of asponsoring employee,i.e.,a direct-hireForeign Service, CivilService,oruniformed service memberwho is permanently assigned to or stationed abroadata U.S. mission,oratan office oftheAmerican Institute inTaiwan,and whoisunder Chiefof Mission authority,and either:
a.Resides atthe sponsoring employee's postof assignmentabroad or,as appropriate,at an office ofthe American InstituteinTaiwan;or
b.Resides ataninvoluntary separate maintenance allowance (ISMA) location,authorized under 3FAM3232.2.Ifresiding atanISMA location, theindividualwill not be listed on the sponsoringofficer'stravelorders but will havea form SF-1190processedauthorizing ISMA.
Other family membersor dependentson direct-hire Foreign Service, Civil Service,or uniformed services member's travel orders are notUSEFMsor AEFMsfor purposes of 3FAM 8200.
Ifyou claimstatusas aU.S.Citizen EFM,MissionHRmay need to verifyyourstatus and eligibility.Mission HR's decision on eligibilityforthe preferenceasa USEFM isfinal.

U.S.Veterans

Ifyou claimstatus as aU.S.Veteran,you mustattach a copyof your DD-214,Certificate ofRelease or Discharge from Active Duty.Failureto provide a copyof yourDD-214 to Mission HR bythe closingdate of theVacancyAnnouncementmeans youlose eligibilityforthe hiringpreference.
Mission HR'sdecision on eligibilityfor U.S.Veterans preference after reviewingtheDD-214, or conditional eligibilitydocumentation, isfinal.
USGMissionsdonotusepointsinapplying the hiring preference for USEFMor U.S.Veteran candidates. USEFM and U.S. Veterancandidates generallyhave an equalpreference in hiring; however,a U.S.Citizen EFMwho is also aU.S.Veteran receives preference inhiring before all other preference candidates.UnderU.S.lawandpolicy,USEFM and U.S. Veteran candidates must be fully qualifiedbefore receiving first consideration for theadvertised position.
EDUCATION
Block19. Education
1.School -If you have graduatestudies beyond a Bachelor’s degree or host country equivalent,startin the first block, "GraduateSchool."Ifyou have college/universitystudies,startin the nextblockdown,"Undergraduate/College University." Ifyou did notattendcollege/university, start with the "HighSchool/General Educational Development(GED)" block.(The GEDtestsarea group offivetests whichwhenpassed,certifies thatthetakerhas AmericanorCanadian high school-level academicskills.)Use theTechnical/Vocationalschoolblockforallother formaleducation.Listthe name ofthe school,city and state.(Example:ClemsonUniversity, Clemson, South Carolina,USA.)
2.Dates Attended -List thedates using themm-yyyy format. (Example: 08-2000.)
3.Graduate -Check either "Yes" or "No."
4.Degree/Diploma and Major Subject -If youare acollege/universityortechnical school graduate,indicate your degreefield under"Degree/Diploma."
Ifyou double majored in school, list your major andminor fieldsof study under "Major Subject." (Example:Major:Economics; Minor:History.)
Ifyouhaveuniversitystudiesbutdidnot graduate,check "No" in the "Graduate"box, write "N/A" in the "Degree/Diploma" block,and write"Generalcourse work" in the "Major Subject" block.
Ifyou havegraduate studies but did notgraduate, check "No" in the "Graduate" box, write "N/A" in the "Degree/Diploma" block andwritethe area of graduate work you were pursuing in the "MajorSubject" block. (Example:"Psychology.")
Ifyouhavetechnicalschool,vocationalschool,orotherformal school education butdid notgraduate,check "No"inthe "Graduate" block,writes "N/A" in the "Degree/Diploma" block,andwrite the main technicalor vocational course work you took.(Example: Welding.)
LANGUAGES
Block20. The Mission assesseslanguage proficiencyusingthe followingstandards:
LevelI=Basicknowledge
Level II =Limited knowledge
Level III= Good WorkingKnowledge
Level IV =Fluent
Level V=Professional Translator/Interpreter
Youmustlistyourlanguageproficiencyusing the Level I-V standard. You must identify one and only one language asyour primary/firstspoken/nativelanguage.Ifyouarebilingualor multi-lingual,youmayonlychooseonelanguageasyour primary/first spoken/nativelanguage. If you arenotproficient inallthree components ofthe language(speaking,reading,and writing),then listyour proficiency in thecomponentsthatapply and write "N/A" in thecomponents thatdo notapply.