[104-10194-10026.pdf — page 234]
# STATEMENT OF PRIOR FEDERAL CIVILIAN AND MILITARY SERVICE AND DETERMINATION OF COMPETITIVE STATUSIMPORTANT: The information on this form will be used (1) in determining creditable service for leave purposes and retention credits for reduction in force, and (2) a recording agency determination of competitive status. The employee should complete Part I and the Personnel Office should complete Parts II through V.PART I.—EMPLOYEE'S STATEMENT1. NAME (Last, first, middle initial)PHILLIPS, DAVID ATLEE2. DATE OF BIRTHOctober 31, 19293. LIST THE FOLLOWING INFORMATION CONCERNING ALL FEDERAL AND DISTRICT OF COLUMBIA SERVICE YOU HAVE HAD PRIOR TO YOUR PRESENT APPOINTMENT (Do not include military service).| NAME AND LOCATION OF AGENCY | FROM           | TO             | TYPE OF APPOINTMENT IF KNOWN | 11. SERVICE    || --------------------------- | -------------- | -------------- | ---------------------------- | -------------- ||                             | YEAR MONTH DAY | YEAR MONTH DAY |                              | YEAR MONTH DAY || CIA                         | 1950 4 1       | 1952 4 13      | C.S.-14                      | 0 4 13         |4. LIST PERIODS OF ACTIVE SERVICE IN ANY BRANCH OF THE ARMED FORCES OF THE UNITED STATES. IF YOU HAD NO ACTIVE MILITARY SERVICE, WRITE "NONE."| BRANCH         | FROM           | TO             | DISCHARGE (Hon. or Dishon.) || -------------- | -------------- | -------------- | --------------------------- ||                | YEAR MONTH DAY | YEAR MONTH DAY |                             || ARMY AIR FORCE | 1952 1 13      | 1955 10 31     | HON.                        |5. DURING PERIODS OF EMPLOYMENT SHOWN IN ITEM 3, DO YOU HAVE A TOTAL OF MORE THAN 6 MONTHS ABSENCE WITHOUT PAY, INCLUDING PERIODS OF MERCHANT MARINE SERVICE, DURING ANY ONE CALENDAR YEAR? ☐ YES ☒ NOIF ANSWER IS "YES," LIST FOLLOWING INFORMATION.| TYPE IF KNOWN (LWOP, Furl, Susp, AWOL, Mer Mar) | FROM           | TO             | TOTAL             || ----------------------------------------------- | -------------- | -------------- | ----------------- ||                                                 | YEAR MONTH DAY | YEAR MONTH DAY | YEARS MONTHS DAYS ||                                                 |                |                |                   |6. DURING THE FEDERAL SERVICE LISTED IN ITEM 3, DID YOU ACQUIRE A PERMANENT COMPETITIVE CIVIL SERVICE STATUS? ☐ YES ☒ NO(If answer is "Yes," in what agency were you employed at the time status was acquired?)7. ARE YOU:A. THE WIFE OF A DISABLED VETERAN? ☐ YES ☒ NOB. THE MOTHER OF A DECEASED OR DISABLED VETERAN? ☐ YES ☒ NOC. THE UNREMARRIED WIDOW OF A VETERAN? ☐ YES ☒ NO8. TO BE EXECUTED BEFORE A NOTARY PUBLIC OR OTHER PERSONS AUTHORIZED TO ADMINISTER OATHS.I swear (or affirm) that the above statements are true to the best of my knowledge and belief.14 March 1960(DATE)David A. Phillips(SIGNATURE)Subscribed and sworn to before me on this day of 1960 at WASHINGTON, D.C.(MONTH) (CITY) (STATE)SEAL*Helen Capiotti*NOTE: If oath is taken before a Notary Public, the date of expiration of his Commission should be shown.INSTRUCTIONS: File this form on the permanent side of the employee's official personnel folder immediately before or after the personnel action involved.(OVER)