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U.S. Department of State OMB APPROVAL NO. 1405-0189 APPLICATION FOR EMPLOYMENT AS A EXPIRES: 12/31/2012 LOCALLY EMPLOYED STAFF OR FAMILY MEMBER ESTIMATED BURDEN: 1 Hour (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 (If known) 4. Date Available for Work (mm-dd-yyyy) PERSONAL INFORMATION 5. Last Name (s) / Surnames First Name Middle Name 6. Other Names Used 7. Date of Birth (mm-