<table>
<colgroup>
<col style="width: 14%" />
<col style="width: 0%" />
<col style="width: 9%" />
<col style="width: 9%" />
<col style="width: 7%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 10%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 18%" />
<col style="width: 13%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="2"><img src="media/image1.wmf"
style="width:0.64583in;height:0.6875in" /></td>
<td colspan="14"><h3 id="application-for-employment"><strong><span
class="smallcaps">APPLICATION FOR EMPLOYMENT</span></strong></h3>
<p><span class="smallcaps">AS A LOCALLY EMPLOYED STAFF
MEMBER</span></p></td>
</tr>
<tr class="even">
<td colspan="14"></td>
</tr>
<tr class="odd">
<td colspan="15"><strong>INSTRUCTIONS: The questions on this application
should be answered fully and completely. Do not use the abbreviation
“N/A” to respond to any question: all questions are applicable and
should be given an appropriate response. Making a false statement on
this form will result in rejection of your application: if discovered
subsequent to your appointment, a false statement is cause for
dismissal.</strong></td>
</tr>
<tr class="even">
<td colspan="5">Indicate Title, Position or Program you are applying
for.</td>
<td colspan="3"></td>
<td colspan="3"><h1 id="job-announcement-number">Job Announcement
Number</h1></td>
<td colspan="2"></td>
<td colspan="2"><h6 id="lowest-acceptable-annual-salary">Lowest
Acceptable Annual Salary</h6></td>
</tr>
<tr class="odd">
<td colspan="15"><h6
id="how-did-you-learn-about-the-job-for-which-you-are-applying">How did
you learn about the job for which you are applying?</h6></td>
</tr>
<tr class="even">
<td colspan="4"><ul>
<li><p><strong>Newspaper / magazine</strong></p></li>
</ul>
<blockquote>
<p><u>which one:</u></p>
</blockquote></td>
<td colspan="8"><ul>
<li><p><strong>Friend or Relative Working for the
Embassy</strong></p></li>
<li><p><strong>Friend or Relative not Working for the
Embassy</strong></p></li>
</ul></td>
<td colspan="3"><p><strong>Embassy website</strong></p>
<p><strong>Other</strong> <em>(please specify):</em></p></td>
</tr>
<tr class="odd">
<td colspan="15"><ol type="1">
<li><p><strong>NAME IN FULL</strong> (Enter regularly used surname with
other names used following in parenthesis - i.e., Spanish or other
double names)</p></li>
</ol>
<p>Mr. (Last) (First) (Middle)</p>
<p>Mrs.</p>
<p>Ms.</p></td>
</tr>
<tr class="even">
<td colspan="15"><strong>2. NAME AT BIRTH, IF DIFFERENT FROM
ABOVE</strong></td>
</tr>
<tr class="odd">
<td colspan="15"><p><strong>3. HAVE YOU EVER BEEN KNOWN BY ANY OTHER
NAMES</strong>?  YES  NO</p>
<p>If yes, give name and explain circumstances under item 19.</p></td>
</tr>
<tr class="even">
<td colspan="9"><p><strong>4. PRESENT ADDRESS AND <u>TELEPHONE
NUMBER</u></strong></p>
<p>(please indicate mobile phone number and e-mail address if you have
one)</p></td>
<td colspan="6"><strong>5. DATE OF BIRTH</strong> (Month, Day,
Year)</td>
</tr>
<tr class="odd">
<td colspan="9"></td>
<td colspan="6"><strong>6. PLACE OF BIRTH</strong> (City, Country)</td>
</tr>
<tr class="even">
<td colspan="3"><h6 id="a.-are-you-a-u.s.-citizen">7 A. ARE YOU A U.S.
CITIZEN?</h6></td>
<td colspan="4">YES NO</td>
<td colspan="7"><strong>B.</strong> <strong>DO YOU HAVE PERMANENT U.S.
RESIDENT STATUS?</strong></td>
<td>YES NO</td>
</tr>
<tr class="odd">
<td colspan="3"><strong>C. ARE YOU HUNGARIAN CITIZEN?</strong></td>
<td colspan="4">YES NO</td>
<td colspan="7"><strong>D. DO YOU HAVE PERMANENT RESIDENT STATUS IN
HUNGARY?</strong></td>
<td>YES NO</td>
</tr>
<tr class="even">
<td colspan="15"><strong>E. IF YOUR ANSWER TO QUESTIONS <u>A</u> OR
<u>B</u> WAS YES, PLEASE ENTER YOUR U.S. SOCIAL SECURITY
NUMBER:</strong></td>
</tr>
<tr class="odd">
<td colspan="15"><strong>8.</strong> <strong>LIST ANY OTHER COUNTRY OF
WHICH YOU HAVE BEEN A CITIZEN</strong></td>
</tr>
<tr class="even">
<td colspan="2">DATES</td>
<td colspan="4">COUNTRY</td>
<td colspan="9">HOW CITIZENSHIP WAS ACQUIRED</td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="4"></td>
<td colspan="9"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="4"></td>
<td colspan="9"></td>
</tr>
<tr class="odd">
<td colspan="6"><strong>9. A. MOTHER’S NAME</strong></td>
<td colspan="4"><strong>B. DATE OF BIRTH</strong></td>
<td colspan="5"><strong>C. PLACE OF BIRTH</strong> (City, Country)</td>
</tr>
<tr class="even">
<td colspan="15"><ol start="10" type="1">
<li><p><strong>DO YOU HAVE A RELATIVE/S WORKING FOR THE EMBASSY? If yes,
please enter name, position and section:</strong></p></li>
</ol></td>
</tr>
<tr class="odd">
<td colspan="15"><strong>11. ARE ANY OF YOUR RELATIVES OR FAMILY MEMBERS
EMPLOYED BY AN AGENCY OR REPRESENTATIVE OF A NATIONAL OR LOCAL
GOVERNMENT IN HUNGARY?</strong> If so, list name, relationship, agency
and agency address. YES NO</td>
</tr>
<tr class="even">
<td colspan="15"></td>
</tr>
<tr class="odd">
<td colspan="15"></td>
</tr>
<tr class="even">
<td colspan="15"></td>
</tr>
<tr class="odd">
<td colspan="15"></td>
</tr>
</tbody>
</table>

<table>
<colgroup>
<col style="width: 19%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 6%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 7%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="23"><strong>12. EDUCATION</strong></td>
</tr>
<tr class="even">
<td colspan="5"><strong>NAMES AND LOCATIONS OF EDUCATIONAL INSTITUTIONS
ATTENDED</strong></td>
<td colspan="5"><h4 id="dates">DATES</h4>
<p>(month, year)</p></td>
<td colspan="5"><h4 id="degrees">DEGREES</h4>
<p>(BA, MA, etc.)</p></td>
<td colspan="4"><h4 id="major">MAJOR</h4>
<h4 id="subjects">SUBJECTS</h4></td>
<td colspan="4"><p><strong>Number of credit hours</strong></p>
<p>(if applicable)</p></td>
</tr>
<tr class="odd">
<td colspan="5"></td>
<td colspan="2">FROM</td>
<td colspan="3">TO</td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="3">semester</td>
<td>quarter</td>
</tr>
<tr class="even">
<td colspan="5"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="5"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="5"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="5"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="5"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="23"><strong>13. ANY OTHER COURSES OR TRAINING
COMPLETED:</strong></td>
</tr>
<tr class="even">
<td colspan="5" rowspan="3"><strong>NAMES AND LOCATIONS OF EDUCATIONAL
INSTITUTIONS ATTENDED</strong></td>
<td colspan="6" rowspan="2"><h4 id="dates-1">DATES</h4>
<p>(month, year)</p></td>
<td colspan="7" rowspan="3"><h4 id="major-1">MAJOR</h4>
<h4 id="subjects-1">SUBJECTS</h4></td>
<td colspan="5"><h4 id="training-completed">TRAINING COMPLETED</h4></td>
</tr>
<tr class="odd">
<td colspan="3" rowspan="2"><h4 id="yes">YES</h4></td>
<td colspan="2" rowspan="2"><h4 id="no">NO</h4></td>
</tr>
<tr class="even">
<td colspan="3"><h4 id="from">FROM</h4></td>
<td colspan="3"><h4 id="to">TO</h4></td>
</tr>
<tr class="odd">
<td colspan="5"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="7"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="5"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="7"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="5"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="7"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="13"><p><strong>14. SPECIAL QUALIFICATIONS AND
SKILLS</strong>. List any special skills you possess such as:</p>
<p>computer skills:</p>
<p>driving license:</p>
<p>other office machine and equipment:</p></td>
<td colspan="10"><p><strong>Approximate number of words per minute
in:</strong></p>
<p>KEYBOARDING- _____________________________</p></td>
</tr>
<tr class="odd">
<td colspan="23"><strong>15. LANGUAGE SKILLS</strong></td>
</tr>
<tr class="even">
<td><strong>LANGUAGE</strong></td>
<td colspan="3"><h4 id="speak">SPEAK</h4></td>
<td colspan="8"><h4 id="read">READ</h4></td>
<td colspan="5"><h4 id="write">WRITE</h4></td>
<td colspan="6"><h4 id="understand">UNDERSTAND</h4></td>
</tr>
<tr class="odd">
<td></td>
<td>EXCELLENT</td>
<td>GOOD</td>
<td>FAIR</td>
<td colspan="2">EXCELLENT</td>
<td colspan="3">GOOD</td>
<td colspan="3">FAIR</td>
<td colspan="2">EXCELLENT</td>
<td colspan="2">GOOD</td>
<td>FAIR</td>
<td colspan="3">EXCELLENT</td>
<td colspan="2">GOOD</td>
<td>FAIR</td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
</tr>
</tbody>
</table>

+---------------------+------------------------+---+----------------------+
| **16. EMPLOYMENT**. |                        |   |                      |
| (In the space       |                        |   |                      |
| provided below      |                        |   |                      |
| describe every      |                        |   |                      |
| position which you  |                        |   |                      |
| have held since you |                        |   |                      |
| first began to      |                        |   |                      |
| work**. Start with  |                        |   |                      |
| Present Position    |                        |   |                      |
| and work back to    |                        |   |                      |
| the first position  |                        |   |                      |
| which you held**.   |                        |   |                      |
| Account for all     |                        |   |                      |
| periods of          |                        |   |                      |
| unemployment and    |                        |   |                      |
| state reasons for   |                        |   |                      |
| any unemployment    |                        |   |                      |
| indicated. If not   |                        |   |                      |
| enough space use    |                        |   |                      |
| Continuation        |                        |   |                      |
| Sheet.)             |                        |   |                      |
+---------------------+------------------------+---+----------------------+
| # May we ask        |                        |   |                      |
|  your present emplo |                        |   |                      |
| yer about your char |                        |   |                      |
| acter, qualificatio |                        |   |                      |
| ns, and work record |                        |   |                      |
| ? A "NO" will not a |                        |   |                      |
| ffect our review of |                        |   |                      |
|  your qualification |                        |   |                      |
| s. If you answer "N |                        |   |                      |
| O" and we need to c |                        |   |                      |
| ontact your present |                        |   |                      |
|  employer before we |                        |   |                      |
|  can offer you a jo |                        |   |                      |
| b, we will contact  |                        |   |                      |
| you first.  YES  NO |                        |   |                      |
+---------------------+------------------------+---+----------------------+
| # WHEN CA           |                        |   |                      |
| N YOU START WORK? * |                        |   |                      |
| (Month and Year)*:  |                        |   |                      |
+---------------------+------------------------+---+----------------------+
| # HOW MU            |                        |   |                      |
| CH NOTICE ARE YOU R |                        |   |                      |
| EQUIRED TO GIVE YOU |                        |   |                      |
| R CURRENT EMPLOYER? |                        |   |                      |
+---------------------+------------------------+---+----------------------+
| A.  **DATES OF      | # EXACT                |   | # SALARY OR EARNINGS |
|     EMPLOYMENT**    | TITLE OF YOUR POSITION |   |                      |
|     (Month, Year)   |                        |   | STARTING HUF / per   |
|                     | Full-time Part-time    |   | year                 |
| **FROM TO**         |                        |   |                      |
|                     |                        |   | FINAL HUF / per year |
+---------------------+------------------------+---+----------------------+
| # NAME AND FULL     | # DU                   |   |                      |
| ADDRESS OF EMPLOYER | TIES - Describe your d |   |                      |
|                     | uties and accomplishme |   |                      |
|                     | nts (include any knowl |   |                      |
|                     | edge, skills, and abil |   |                      |
|                     | ities listed in the va |   |                      |
|                     | cancy announcement tha |   |                      |
|                     | t you have gained from |   |                      |
|                     |  this work experience) |   |                      |
+---------------------+------------------------+---+----------------------+
| **REASON FOR        |                        |   |                      |
| LEAVING**           |                        |   |                      |
+---------------------+------------------------+---+----------------------+
| **B. DATES OF       | # EXACT                | # |                      |
| EMPLOYMENT**        | TITLE OF YOUR POSITION |   |                      |
| (Month, Year)       |                        | S |                      |
|                     | Full-time Part-time    | A |                      |
| **FROM TO**         |                        | L |                      |
|                     |                        | A |                      |
|                     |                        | R |                      |
|                     |                        | Y |                      |
|                     |                        |   |                      |
|                     |                        | O |                      |
|                     |                        | R |                      |
|                     |                        |   |                      |
|                     |                        | E |                      |
|                     |                        | A |                      |
|                     |                        | R |                      |
|                     |                        | N |                      |
|                     |                        | I |                      |
|                     |                        | N |                      |
|                     |                        | G |                      |
|                     |                        | S |                      |
|                     |                        |   |                      |
|                     |                        | S |                      |
|                     |                        | T |                      |
|                     |                        | A |                      |
|                     |                        | R |                      |
|                     |                        | T |                      |
|                     |                        | I |                      |
|                     |                        | N |                      |
|                     |                        | G |                      |
|                     |                        | H |                      |
|                     |                        | U |                      |
|                     |                        | F |                      |
|                     |                        | / |                      |
|                     |                        | p |                      |
|                     |                        | e |                      |
|                     |                        | r |                      |
|                     |                        | y |                      |
|                     |                        | e |                      |
|                     |                        | a |                      |
|                     |                        | r |                      |
|                     |                        |   |                      |
|                     |                        | F |                      |
|                     |                        | I |                      |
|                     |                        | N |                      |
|                     |                        | A |                      |
|                     |                        | L |                      |
|                     |                        | H |                      |
|                     |                        | U |                      |
|                     |                        | F |                      |
|                     |                        | / |                      |
|                     |                        | p |                      |
|                     |                        | e |                      |
|                     |                        | r |                      |
|                     |                        | y |                      |
|                     |                        | e |                      |
|                     |                        | a |                      |
|                     |                        | r |                      |
+---------------------+------------------------+---+----------------------+
| # NAME AND FULL     | # DU                   |   |                      |
| ADDRESS OF EMPLOYER | TIES - Describe your d |   |                      |
|                     | uties and accomplishme |   |                      |
|                     | nts (include any knowl |   |                      |
|                     | edge, skills, and abil |   |                      |
|                     | ities listed in the va |   |                      |
|                     | cancy announcement tha |   |                      |
|                     | t you have gained from |   |                      |
|                     |  this work experience) |   |                      |
+---------------------+------------------------+---+----------------------+
| #                   |                        |   |                      |
|  REASON FOR LEAVING |                        |   |                      |
+---------------------+------------------------+---+----------------------+
| C.  **DATES OF      | # EXACT                | # |                      |
|     EMPLOYMENT**    | TITLE OF YOUR POSITION |   |                      |
|     (Month, Year)   |                        | S |                      |
|                     | Full-time Part-time    | A |                      |
| **FROM TO**         |                        | L |                      |
|                     |                        | A |                      |
|                     |                        | R |                      |
|                     |                        | Y |                      |
|                     |                        |   |                      |
|                     |                        | O |                      |
|                     |                        | R |                      |
|                     |                        |   |                      |
|                     |                        | E |                      |
|                     |                        | A |                      |
|                     |                        | R |                      |
|                     |                        | N |                      |
|                     |                        | I |                      |
|                     |                        | N |                      |
|                     |                        | G |                      |
|                     |                        | S |                      |
|                     |                        |   |                      |
|                     |                        | S |                      |
|                     |                        | T |                      |
|                     |                        | A |                      |
|                     |                        | R |                      |
|                     |                        | T |                      |
|                     |                        | I |                      |
|                     |                        | N |                      |
|                     |                        | G |                      |
|                     |                        | H |                      |
|                     |                        | U |                      |
|                     |                        | F |                      |
|                     |                        | / |                      |
|                     |                        | p |                      |
|                     |                        | e |                      |
|                     |                        | r |                      |
|                     |                        | y |                      |
|                     |                        | e |                      |
|                     |                        | a |                      |
|                     |                        | r |                      |
|                     |                        |   |                      |
|                     |                        | F |                      |
|                     |                        | I |                      |
|                     |                        | N |                      |
|                     |                        | A |                      |
|                     |                        | L |                      |
|                     |                        | H |                      |
|                     |                        | U |                      |
|                     |                        | F |                      |
|                     |                        | / |                      |
|                     |                        | p |                      |
|                     |                        | e |                      |
|                     |                        | r |                      |
|                     |                        | y |                      |
|                     |                        | e |                      |
|                     |                        | a |                      |
|                     |                        | r |                      |
+---------------------+------------------------+---+----------------------+
| # NAME AND FULL     | # DU                   |   |                      |
| ADDRESS OF EMPLOYER | TIES - Describe your d |   |                      |
|                     | uties and accomplishme |   |                      |
|                     | nts (include any knowl |   |                      |
|                     | edge, skills, and abil |   |                      |
|                     | ities listed in the va |   |                      |
|                     | cancy announcement tha |   |                      |
|                     | t you have gained from |   |                      |
|                     |  this work experience) |   |                      |
+---------------------+------------------------+---+----------------------+
| #                   |                        |   |                      |
|  REASON FOR LEAVING |                        |   |                      |
+---------------------+------------------------+---+----------------------+

**[Continuation sheet]{.smallcaps}**

+------------------------+---------------------+-----------------------+
| D.  **DATES OF         | # EXACT TIT         | # SALARY OR EARNINGS  |
|     EMPLOYMENT**       | LE OF YOUR POSITION |                       |
|     (Month, Year)      |                     | STARTING HUF / per    |
|                        | Full-time Part-time | year                  |
| # FROM TO              |                     |                       |
|                        |                     | FINAL HUF / per year  |
+------------------------+---------------------+-----------------------+
| **NAME AND FULL        | # DUTIES            |                       |
| ADDRESS OF EMPLOYER**  | - Describe your dut |                       |
|                        | ies and accomplishm |                       |
|                        | ents (include any k |                       |
|                        | nowledge, skills, a |                       |
|                        | nd abilities listed |                       |
|                        |  in the vacancy ann |                       |
|                        | ouncement that you  |                       |
|                        | have gained from th |                       |
|                        | is work experience) |                       |
+------------------------+---------------------+-----------------------+
| # REASON FOR LEAVING   |                     |                       |
+------------------------+---------------------+-----------------------+
| E.  **DATES OF         | # EXACT TIT         | # SALARY OR EARNINGS  |
|     EMPLOYMENT**       | LE OF YOUR POSITION |                       |
|     (Month, Year)      |                     | STARTING HUF / per    |
|                        | Full-time Part-time | year                  |
| # FROM TO              |                     |                       |
|                        |                     | FINAL HUF / per year  |
+------------------------+---------------------+-----------------------+
| **NAME AND FULL        | # DUTIES            |                       |
| ADDRESS OF EMPLOYER**  | - Describe your dut |                       |
|                        | ies and accomplishm |                       |
|                        | ents (include any k |                       |
|                        | nowledge, skills, a |                       |
|                        | nd abilities listed |                       |
|                        |  in the vacancy ann |                       |
|                        | ouncement that you  |                       |
|                        | have gained from th |                       |
|                        | is work experience) |                       |
+------------------------+---------------------+-----------------------+
| # REASON FOR LEAVING   |                     |                       |
+------------------------+---------------------+-----------------------+
| F.  **DATES OF         | # EXACT TIT         | # SALARY OR EARNINGS  |
|     EMPLOYMENT**       | LE OF YOUR POSITION |                       |
|     (Month, Year)      |                     | STARTING HUF / per    |
|                        | Full-time Part-time | year                  |
| # FROM TO              |                     |                       |
|                        |                     | FINAL HUF / per year  |
+------------------------+---------------------+-----------------------+
| **NAME AND FULL        | # DUTIES            |                       |
| ADDRESS OF EMPLOYER**  | - Describe your dut |                       |
|                        | ies and accomplishm |                       |
|                        | ents (include any k |                       |
|                        | nowledge, skills, a |                       |
|                        | nd abilities listed |                       |
|                        |  in the vacancy ann |                       |
|                        | ouncement that you  |                       |
|                        | have gained from th |                       |
|                        | is work experience) |                       |
+------------------------+---------------------+-----------------------+
| # REASON FOR LEAVING   |                     |                       |
+------------------------+---------------------+-----------------------+
| G.  **DATES OF         | # EXACT TIT         | # SALARY OR EARNINGS  |
|     EMPLOYMENT**       | LE OF YOUR POSITION |                       |
|     (Month, Year)      |                     | STARTING HUF / per    |
|                        | Full-time Part-time | year                  |
| # FROM TO              |                     |                       |
|                        |                     | FINAL HUF / per year  |
+------------------------+---------------------+-----------------------+
| **NAME AND FULL        | **DUTIES**          |                       |
| ADDRESS OF EMPLOYER**  |                     |                       |
+------------------------+---------------------+-----------------------+
| # REASON FOR LEAVING   |                     |                       |
+------------------------+---------------------+-----------------------+

+-----------------------------------------------------+---+---+---+------+
| **17. ANSWER ALL QUESTIONS IN ITEM 17 BY PLACING AN |   | * |   | **   |
| "X" IN THE PROPER COLUMN**                          |   | * |   | NO** |
|                                                     |   | Y |   |      |
|                                                     |   | E |   |      |
|                                                     |   | S |   |      |
|                                                     |   | * |   |      |
|                                                     |   | * |   |      |
+-----------------------------------------------------+---+---+---+------+
| 17\. / A. HAVE YOU EVER BEEN DISCHARGED OR FORCED   |   |   |   |      |
| TO RESIGN FOR MISCONDUCT OR UNSATISFACTORY SERVICE  |   |   |   |      |
| FROM A POSITION? IF ANSWER IS "YES" GIVE DETAILS    |   |   |   |      |
| BELOW.                                              |   |   |   |      |
+-----------------------------------------------------+---+---+---+------+
| / B. HAVE YOU NOW OR HAVE YOU EVER HAD ANY PHYSICAL |   |   |   |      |
| LIMITATIONS?                                        |   |   |   |      |
+-----------------------------------------------------+---+---+---+------+
| / C. ARE YOU NOW UNDER A PHYSICIAN'S CARE AND IF    |   |   |   |      |
| SO, FOR WHAT REASON?                                |   |   |   |      |
+-----------------------------------------------------+---+---+---+------+
| / D. HAVE YOU EVER HAD A NERVOUS DISORDER?          |   |   |   |      |
+-----------------------------------------------------+---+---+---+------+
| / E. HAVE YOU EVER HAD TUBERCULOSIS?                |   |   |   |      |
+-----------------------------------------------------+---+---+---+------+
| / F. WITHIN THE PAST 12 MONTHS, HAVE YOU USED       |   |   |   |      |
| INTOXICATING BEVERAGES TO EXCESS?                   |   |   |   |      |
+-----------------------------------------------------+---+---+---+------+
| / G. DO YOU HAVE A DRUG OR NARCOTIC ADDICTION?      |   |   |   |      |
+-----------------------------------------------------+---+---+---+------+
| / H. WERE YOU EVER MEDICALLY DISCHARGED FROM THE    |   |   |   |      |
| ARMED FORCES?                                       |   |   |   |      |
+-----------------------------------------------------+---+---+---+------+
| # IF ANY OF YOUR ANSWERS                            |   |   |   |      |
| TO ANY OF THE ABOVE IS "YES", GIVE PARTICULARS HERE |   |   |   |      |
+-----------------------------------------------------+---+---+---+------+
| **18. HAVE YOU EVER BEEN ARRESTED, DETAINED OR      |   |   |   |      |
| SENTENCED BY ANY PLACE OR MILITARY AUTHORITY?** (if |   |   |   |      |
| so, name the authority, give time, place, reason    |   |   |   |      |
| and disposition of court action)                    |   |   |   |      |
+-----------------------------------------------------+---+---+---+------+
| **19. USE THIS SPACE FOR DETAILED ANSWERS, NUMBER   |   |   |   |      |
| ANSWERS TO CORRESPOND WITH QUESTIONS, ADD ANY       |   |   |   |      |
| INFORMATION NOT COVERED ABOVE WHICH MIGHT AFFECT    |   |   |   |      |
| YOUR EMPLOYMENT, USE EXTRA BLANK PAGES, IF          |   |   |   |      |
| NECESSARY.**                                        |   |   |   |      |
+-----------------------------------------------------+---+---+---+------+

+----------------------------------+-----------------------------------+
| **20. MILITARY SERVICE**         |                                   |
| (Outline military service past   |                                   |
| or present, giving country of    |                                   |
| service, branch of service, unit |                                   |
| or organization, specialist,     |                                   |
| highest rank held, dates of      |                                   |
| service, present rank, and date  |                                   |
| and type of discharge.)          |                                   |
+----------------------------------+-----------------------------------+
| #                                |                                   |
|  [NON-U.S. Citizens only]{.mark} |                                   |
|                                  |                                   |
| #                                |                                   |
+----------------------------------+-----------------------------------+
|                                  |                                   |
+----------------------------------+-----------------------------------+
|                                  |                                   |
+----------------------------------+-----------------------------------+
| ## [U.S. Citizens only]{.mark}   |                                   |
+----------------------------------+-----------------------------------+
|                                  |                                   |
+----------------------------------+-----------------------------------+
|                                  |                                   |
+----------------------------------+-----------------------------------+
| # [V                             | **[The 10-Point Preference groups |
| eteran's Preference]{.underline} | are:]{.underline}**               |
|                                  |                                   |
|                                  | > Non-Compensably Disabled or     |
|                                  | > Purple Heart Recipient.         |
|                                  | >                                 |
|                                  | > Compensably Disabled (less than |
|                                  | > 30%).                           |
|                                  | >                                 |
|                                  | > Compensably Disabled (30% or    |
|                                  | > more).                          |
|                                  | >                                 |
|                                  | > Spouse, Widow(er) or Mother of  |
|                                  | > a deceased or disabled veteran. |
|                                  |                                   |
|                                  | To receive "10-Point Preference", |
|                                  | you must send in a completed      |
|                                  | SF-15 with the proof requested in |
|                                  | the SF-15.                        |
+----------------------------------+-----------------------------------+
| No Preference                    |                                   |
+----------------------------------+-----------------------------------+
| 5-Point Preference               |                                   |
+----------------------------------+-----------------------------------+
| 10-Point Preference              |                                   |
+----------------------------------+-----------------------------------+
| SPECIFIC INSTRUCTIONS:           |                                   |
|                                  |                                   |
| If you do not claim veteran's    |                                   |
| preference, mark the "No         |                                   |
| Preference" circle. You          |                                   |
| **cannot** receive veteran's     |                                   |
| preference if you are retired or |                                   |
| plan to retire at or above the   |                                   |
| rank of major or lieutenant      |                                   |
| commander, **unless** you are    |                                   |
| disabled or retired from the     |                                   |
| active military Reserve. To      |                                   |
| receive veteran's preference,    |                                   |
| your separation from active duty |                                   |
| must have been under honorable   |                                   |
| conditions. This includes        |                                   |
| honorable and general            |                                   |
| discharges. A clemency discharge |                                   |
| does not meet the requirements   |                                   |
| of the Veteran's Preference Act. |                                   |
| Active duty for training in the  |                                   |
| military Reserve and National    |                                   |
| Guard programs is not considered |                                   |
| active duty for purposes of      |                                   |
| veteran's preference.            |                                   |
|                                  |                                   |
| To qualify for preference, you   |                                   |
| must meet ONE of the following   |                                   |
| conditions:                      |                                   |
|                                  |                                   |
| 1\. Served on active duty        |                                   |
| anytime between December 7, 1941 |                                   |
| and July 1, 1955; (If you were a |                                   |
| Reservist called to active duty  |                                   |
| between February 1, 1955 and     |                                   |
| July 1, 1955, you must meet      |                                   |
| condition 2, below.) **or**      |                                   |
|                                  |                                   |
| 2\. Served on active duty any    |                                   |
| part of which was between July   |                                   |
| 2, 1955 and October 14, 1976 or  |                                   |
| a Reservist called to active     |                                   |
| duty between February 1, 1955    |                                   |
| and October 14, 1976 **and** who |                                   |
| served more than 180 days;       |                                   |
| **or**                           |                                   |
|                                  |                                   |
| 3\. Entered on active duty       |                                   |
| between October 15, 1976 and     |                                   |
| September 7, 1980 or a Reservist |                                   |
| who entered on active duty       |                                   |
| between October 15, 1976 and     |                                   |
| October 13, 1982 **and**         |                                   |
| received a Campaign Badge or     |                                   |
| Expeditionary Medal or are a     |                                   |
| disabled veteran; **or**         |                                   |
|                                  |                                   |
| 4\. Enlisted in the Armed Forces |                                   |
| after September 7, 1980 or       |                                   |
| entered active duty other than   |                                   |
| by enlistment on or after        |                                   |
| October 14, 1982 **and:**        |                                   |
|                                  |                                   |
| a.  Completed 24 months of       |                                   |
|     continuous active duty, or   |                                   |
|     the full period called, or   |                                   |
|     ordered to active duty, or   |                                   |
|     were discharged under 10     |                                   |
|     U.S.C. 1171, or for hardship |                                   |
|     under U.S.C. 1173, **and**   |                                   |
|     received or were entitled to |                                   |
|     receive a Campaign Badge or  |                                   |
|     Expeditionary Medal; or      |                                   |
|                                  |                                   |
| b.  Are a disabled veteran.      |                                   |
|                                  |                                   |
| If you meet one of the previous  |                                   |
| four conditions, you qualify for |                                   |
| 5-Point Preference. If you want  |                                   |
| to claim 5-Point Preference and  |                                   |
| do not meet the requirements for |                                   |
| 10-Point Preference, mark the    |                                   |
| circle next to "5-Point          |                                   |
| Preference".                     |                                   |
+----------------------------------+-----------------------------------+
| PRIVACY ACT STATEMENT            |                                   |
|                                  |                                   |
| (APPLICABLE ONLY TO APPLICANTS   |                                   |
| WHO ARE RESIDENT ALIENS OF THE   |                                   |
| U.S.)                            |                                   |
+----------------------------------+-----------------------------------+
| The Foreign Service act of 1980, |                                   |
| as amended, implies the          |                                   |
| authority to solicit personal    |                                   |
| information from individuals due |                                   |
| to its relevance to the          |                                   |
| appointment, training,           |                                   |
| evaluation and assignment        |                                   |
| processes. This information is   |                                   |
| used by the Department of State  |                                   |
| to assist in evaluating your     |                                   |
| qualifications for employment in |                                   |
| the Foreign Service. the         |                                   |
| information you furnish will be  |                                   |
| reviewed by authorized persons   |                                   |
| within the Department of States  |                                   |
| and other agencies at posts      |                                   |
| abroad as requested. Failure to  |                                   |
| answer all applicable questions  |                                   |
| on this form may delay           |                                   |
| consideration of your            |                                   |
| application and could result in  |                                   |
| you not receiving full           |                                   |
| consideration for a position in  |                                   |
| which this information is        |                                   |
| needed.                          |                                   |
+----------------------------------+-----------------------------------+
| #### CERTIFICATION               |                                   |
+----------------------------------+-----------------------------------+
| BEFORE SIGNING THIS FORM MAKE    |                                   |
| SURE YOU HAVE ANSWERED ALL       |                                   |
| QUESTIONS FULLY AND COMPLETELY.  |                                   |
| A FALSE STATEMENT ON THIS        |                                   |
| APPLICATION IS CAUSE FOR         |                                   |
| DISMISSAL.                       |                                   |
+----------------------------------+-----------------------------------+
| **I DO SOLEMNLY AFFIRM THAT THE  |                                   |
| INFORMATION CONTAINED HEREIN IS  |                                   |
| CORRECT TO THE BEST OF MY        |                                   |
| KNOWLEDGE AND BELIEF.**          |                                   |
|                                  |                                   |
| ##                               |                                   |
|                                  |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_                   |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
|                                  |                                   |
| (NAME AS USUALLY WRITTEN AND     |                                   |
| WHICH WILL BE USED AS OFFICIAL   |                                   |
| SIGNATURE) DATE                  |                                   |
+----------------------------------+-----------------------------------+