Enter the name, address, and telephone number of foreign mission
consulate, or office where the employee will be assigned. NOTE: For
domestic employees, give the name, Personal
Identification Number (PID), and title of the employer, and his/her
complete office address.
Enter the name, address, and telephone number of the actual office or
annex where the employee will be working, if different from Number 12.
NOTE: For domestic employees, give the residence address where
domestic duties will be performed.
NOTE: All addresses must be street addresses, including type,
e.g. Street, Ave., Blvd., etc., not post office box numbers, and must
include ZIP codes and telephone area codes.
Enter person's title or position, e.g. secretary, clerk, driver, cook, etc.
Do not use any diplomatic or consular title reserved for officer.
Enter the date (mm-dd-yyyy), employee assumed present official
duties in the United States.
Enter the date (mm-yyyy) (approximate) that employee will terminate
duties in the United States.*
Enter name, title and (PID), if available, of the person the employee is
replacing. Enter date (mm-yyyy), of termination of predecessor. If new
position, so state. (Not applicable for domestic workers.)*
If employee will serve in any official capacity other than that that
listed in Number 14, enter position title and mission. Separate
notification will be required.*
If not listed in item 21, enter dates (mm-yyyy), nature of all previous
assignments (including study and training) and place (city and state)
in the United States. List To/From month/Year (mm-yyyy)*.
Enter the dates (mm-yyyy), nature of employment (job title and
employer), and place (city and country) of academic study or other
activities for previous 5 years, starting from the most recent
assignment prior to this one. List to/From--Month/Year (mm-yyyy).
(NOTE: For Numbers, 20, 21, attach additional sheet, if necessary.)*
If a family member (spouse or dependent) is or will be employed in
the United States by a foreign government or international
organization, please identify and indicate position or title,
relationship and where the person is working. The person must be
notified separately to the Office of Protocol using the appropriate
Enter names of all eligible family members residing in the household
in the United States, following the same format as in Number 3
above. Use Form DS-2007 for additional names. Give date of birth
(mm-dd-yyyy), place of birth, (city country), current citizenship, and
relationship to principle employee. Enter type of United States visa
(A-1, B-2, etc.) currently held, or copy of Permanent Resident Alien
Enter "X" in appropriate boxes for an identification card. For
embassy A&T staff (a) principals (who are not U.S. citizens,
permanent resident aliens or determined to be "permanently resident
in the U.S.), (b) spouses (except U.S. citizens, spouses of persons
determined to be "permanently resident in" the U.S., and permanent
resident aliens), (c) dependents of persons determined to be
"permanent resident aliens and dependents of person determined to
be "permanent resident in" the U.S.)
who are unmarried children between 16 and 21 years who reside
with their parents or are full-time students, or unmarried children
under 23 years who are full-time students (for students between 21
and 23 attach family status justification form), for consular officers
only the consular employees and embassy service staff, principals
(who are not U.S. citizens, permanent resident aliens or determined
to be "permanently resident in" the U.S.) unless the sending state
and the U.S. have entered into a bilateral agreement extending
immunity to family members. Other employees and family members
do not receive identification cards.* The employee must sign and
date (mm-dd-yyyy) the form. In case of domestic employees, the
official employers must also sign and date the form. The form must
be signed and dated (mm-dd-yyyy) by the designated approving
embassy official and the official embassy seal must
*Not required if person being registered is U.S. Citizen or Permanent Resident Alien
Submit forms and attachments to
U.S. Department of State
3507 International Place, NW
Washington, DC 20008-3034
ANY CHANGES IN THE INFORMATION PROVIDED ON THIS FORM SHOULD BE REPORTED AS SOON AS POSSIBLE USING THE NOTIFICATION OF CHANGE,
Instruction page 2 of 2