Francesco/who-killed-jfk huggingface dataset:
[104-10194-10026.pdf — page 266]
SECRET(When Filled In)# REQUEST FOR MEDICAL EVALUATION1. DATE OF REQUEST2. NAME (Last, First, Middle)**PHILLIPS, DAVID A.**3. POSITION TITLE**006.0-01**4. GRADE**GS-11**5. OFFICE, DIVISION, BRANCH**MP/DH CS/CL Development Complement**6. EMPLOYEE'S EXT.7. PURPOSE OF EVALUATION*   PRE-EMPLOYMENT*   ENTRANCE ON DUTY*   OVERSEAS RETURN*   TDY STANDBY*   SPECIAL TRAINING*   ANNUAL*   RETURN TO DUTY*   FITNESS FOR DUTY*   MEDICAL RETIREMENT*   OVERSEAS ASSIGNMENT*   ETO*   STATION*   TDY OR PCS*   TYPE OF COVER*   NO. OF DEPENDENTS TO ACCOMPANY*   NO. OF DEPENDENTS' REPORTS OF MEDICAL HISTORY (SF 39) ATTACHED8. OVERSEAS PLANNING EVALUATION (One block must be checked)*   YES*   NO9. REQUESTING OFFICERSIGNATURE**POD H. CA-RITT**ROOM NO. & BUILDING**1504 Cunda**EXT.**8372**10. REPORT OF EVALUATIONPLEASE TYPEDATESIGNATURE FOR CHIEF OF MEDICAL STAFFFORM66-01 259USE PREVIOUS EDITIONS.SECRET(26)
[104-10194-10026.pdf — page 267]
# SECRET(When Filled in)## REQUEST FOR MEDICAL EVALUATION2. NAME (Last, First, Middle):   PHILLIPS, JATID A. (DEPEND MTS)5. OFFICE, DIVISION, BRANCH:   IDP/WH CS/(3 Development Complement1. DATE OF REQUEST3. POSITION TITLE:   OSOFT ER4. GRADE:   146. EMPLOYEE'S EXT.7. PURPOSE OF EVALUATIONOVERSEAS ASSIGNMENTETOSTATIONTDY OR PCSTYPE OF COVERNO. OF DEPENDENTS TO ACCOMPANYNO. OF DEPENDENTS' REPORTS OF MEDICAL HISTORY (SP 89) ATTALHEDPRE-EMPLOYMENTENTRANCE ON DUTYOVERSEAS RETURNTOY STANDBYSPECIAL TRAININGANNUALRETURN TO DUTYPITNESS FOR DUTYMEDICAL RETIREMENT8. OVERSEAS PLANNING EVALUATION (One block must be checked)YESNOSIGNATURE:POD H. CapriottiROOM NO. & BUILDING:1504 Curie9. REQUESTING OFFICEREXT.:837110. REPORT OF EVALUATIONPLEASE EXPHITE (DEPENDENTS)DATESIGNATURE FOR CHIEF OF MEDICAL STAFFFORM10-88 259USE PREVIOUS EDITIONS.SECRET(26)
[104-10194-10026.pdf — page 268]
SECRET(When Filled In)MEDICAL ACTION REQUEST AND REPORTI REQUEST FOR PHYSICAL EXAMINATION BY1. NAME   (Last)   PHILLIPS, DAVID A.   (First)   Ralph S. Pollock, C/CPD   (Middle)2. DATE   20 Jan 563. TO POSITION   Operations Officer (PP)4. OFFICE, DIVISION, BRANCH   DDP/AH5. GRADE   CS-146. TYPE OF POSITION   Departmental   U.S. Field   Overseas7. EVALUATE FOR   EOD   Overseas   Returnee   Pre-Employment   Annual   Special (Specify:   Please notify Ken Vambold only, 2508 Curie Hall, x3585II REPORT OF MEDICAL EVALUATIONQualified for Full Duty (General)Qualified for Departmental Duty OnlyQualified for Full Duty (Special)DisqualifiedRemarks:Subject is qualified for proposed PCS O/S assignment. (1-16-56)MEDICAL OFFICESECRET(When Filled In)MEDICAL ACTION REQUEST AND REPORTI REQUEST FOR PHYSICAL EXAMINATION BY1. NAME   (Last)   Phillips,   (First)   David A.   (Middle)2. DATE   12 Dec., 19553. TO POSITION4. OFFICE, DIVISION, BRANCH   WH5. GRADE   OS-126. TYPE OF POSITION   Departmental   U.S. Field   Overseas7. EVALUATE FOR   EOD   Overseas   Returnee   Pre-Employment   Annual   Special (Specify)II REPORT OF MEDICAL EVALUATIONQualified for Full Duty (General)Qualified for Departmental Duty OnlyQualified for Full Duty (Special)DisqualifiedRemarks:Subject is qualified for proposed 7 days TDY assignment. (12/12/55)Must have a physical examination on return form trip.This memo supersedes previous qualification.MEDICAL OFFICE
[104-10194-10026.pdf — page 269]
SECRET(When Filled In)MEDICAL ACTION REQUEST AND REPORT1 REQUEST. PHYSICAL EXAMINATION BY1. NAME PHILLIPS DAVID ATLEE 2. DATE 30 Dec 19553. TO POSITION N.H. 5. GRADE GS-146. TYPE OF POSITION 7. EVALUATE FORDepartmental EOD Pre-EmploymentU.S. Field 1751456 Overseas AnnualOverseas PCS Returnee Speciale (Specify)Cuba11 REPORT OF MEDICAL EVALUATIONQualified for Full Duty (General) Qualified for Full Duty (Special)Qualified for Departmental Duty Only DisquellfledRemarks: Subject is qualified for proposed PCS O/S assignment. (1/16/56)![signature of medical office]MEDICAL ACTION REQUEST AND REPORTI REQUEST FOR PHYSICAL EXAMINATION BY1. NAME PHILLIPS, DAVID A. 2. DATE 2 August 19543. TO POSITION 4. OFFICE, DIVISION, BRANCH WH 5. GRADE GS 126. TYPE OF POSITION 7. EVALUATE FORDepartmental EOD Pre-EmploymentU.S. Field Overseas AnnualOverseas Guptampla Returnee Special Specify)11 REPORT OF MEDICAL EVALUATIONQualified for Full Duty (General) Quallfies for Full Buty special.Qualified for Departmental Duty Only DisqualifiedRemarks: WH #I Mr. GAHAGANx 3995Full duty/General'8-9-54).![signature of Jonepi J. Macr]
[104-10194-10026.pdf — page 271]
# CERTIFICATION OF LANGUAGE PROFICIENCYPHILLIPS, DAVIDLAN.COLANGLAGE CATA AFTO TESTOCATE TESSUIT Γ.Α12/15/6010/31/22YLAIS16C CHANGECCLETEDATE 10SEASETESTEDPERSONNOTICE٢٧٢10. ON THE DATE SHOWN IN ITEM 6 ABOVE, YOU WERE HESTED INAND YOUR TEST SCORES ARE AS FOLLOWS:PORTUGUESE (BRASILIAN) SNAME OF LANGUAGE)READINGWEITING.PRONUNCIATION SPEASINGUNDERSTANDINGTESTRATINGS0 = ZERO I = INTERMEDIATE* ELEMENTASYN NATIVE  I+ + + + 12.31GNATURE11. REMARAS13. LO NUMBER    17603    I- OPCAS    FORM    11-64    1273    OBSOLETE PREVIOUS    EDITIONS    (10-45) SECRET    GROUP I    EXCLUDED OMATIC DOWNGRADING    CLASSICATION    Phillip Devid A.# QUALIFICATIONS SYSTEM RECORD CHANGEAPPLICANT CODING DATA1. 1012. APPL. NO.    D-DIGITS3. NAME   MUST CONTAIN 20-DIGITS   2   DATE OF DIRTH   5 DATE COOCO   MO   DA   YA   MO   DA   YR   THE DATA ADOVE (11645 2 THAU 5) VILL OC FILLED IN   SHEN CODING AN APPLICANT FOR THE FIRST TINE. THIS   FOON IS THEN ATTACHED TO FORM 1962, MASTER QUALIFICA-   TIONS CODING RECORD.1,1012 EMPLOYCE NO. 3 NAME3-LETTEASLANGUAGE COOING DATA FORM14 LANGUAGE DATA 'CODEBASE CODE 'RPSUTYR313 DATE SUBMITTED6. DATE OF BIRTHMODAYRMODAYAWHEN FORM 4440 DENOTES NO LANGUAGECOMPETENCE, ENTER THE FOLLOWING INITEM 4: "NO LANGUAGE" (12-DIGITS)11. 1012 EMPLOYEC NO 3. NAME3-LETTERSLANGUAGE PROFICIENCY TEST DATAC-A-D5. LANGUAGE CATA BEFORE TESTBASERWFSTYR124345 PHICBk5d Esiii46C. LANGUAGE DATA AFTER. TEST17. DATE OF TESTDATA FOR ITEM 2 THAU 7 13HODATAEXTRACTCO FROM FORM 1273.JASC COυςRWPS UTYRBK5QFT04416346LANGUAGE PROFICIENCY ANDAWARDS DATA.3304The authorization to process this expicyee's disclaia ofproficiency in the language factors indicated on this form iscontained in a memorandum on file and designated "LanguageProficiency Disclaim File", located in the CalificationsAnalysis Branch, Office of Personnel.
[104-10194-10026.pdf — page 272]
# PERSONAL HISTORY STATEMENTINSTRUCTIONS-DO NOT ATTEMPT TO COMPLETE THIS FORM UNTIL YOU HAVE READ THE FOLLOWING INSTRUCTIONS-1. Answer all questions completely or check (X) the box which applies. If the question is not applicable, write "NA". If you do not know the answer and it cannot be obtained from personal records, write "Unknown". Use the blank space on pages 15 and 16 for extra details on any question for which you do not have enough space.2. Type or point carefully - USE BLACK TYPEWRITER RIBBON ÖR BLACK INK.3. Leave blank any boxes or columns which are marked "FOR OFFICE USE ONLY".4. Consider each of your answers carefully, accurate completion of the form will permit review of your qualifications to the best advantage. Your signature at the end of the form will certify to its correctness.5. Page 17 entitled "Personal History Summary" must be completed. It is a brief abstract of information from other parts of the form and will help to speed the processing of your application.SECTION I## GENERAL PERSONAL AND PHYSICAL DATA1. Full Nome (Last Sust-middle)Amcin, Virginia, Simmons2. Age263. Sex$Female4. Social security number579-54-52335. NicknamesGina6. Other nomes you have usedN/A7. ladicate circumstances (including length of time) under which you have sued the names noted in item & aboveN/A8 If legal change of name, give particulars (Where and by what authority)N/A9. Height5' 310. Weight10511. Color of eyesgreen12. Color of boirblond13. Type of complexionfair14. Buildslight15. Scam (Type and location)appendi.:, stomach16. Other distinguishing physical fegheresN/A17 Current address (Ne, Street, City, State & ZIP code-country if not U.S.J9741 Corral Dr., Potomac, Maryland2035418. Corrent phone sumber299-536219. Long distance area code30120 Permanent address (No, Street, City, State & ZIP code country of not U.S)9741 Corral Dr., Potomac, tietyland2005421 Permanent phone number299-536222 Long distance orea code30123 Office phone number332-273024. Office esteπιφηN/A25 Legal rendence (State, erritory of country)MarylandSECTION II## POSITION DATA1. Indicate the type of work or position for which you are applying2 Indicate the lowest annval entrance salary you will accept$3 Dates available for emplaymagnéfori.estLatest4 ledicate your willingness to travel5. Indicate your willingness to accept aangnment in the following locations-chockOccasionallyOther (Specify)6 Indicate any reactions you world place on camerasutude the Washington, DC resEach item applicable$Washington, D.C.Ostarde continatal USApulture in U.S.Cortone lecomhans saly (Spe(For Office Use Only)FORM444USH MENOVI LOITIONS1THIS SHEET MUST BE COMPLETEDDate of this application
[104-10194-10026.pdf — page 273]
### SECTION III**CITIZENSHIP**1. Date of birth2-26-432. Place of birth (City, State, Country)Philadelphia, Pennsylvania3. Principal citizenship (Country)U.S.4. Citizenship acquired by:* Birth* Marriage* Other (Specify)5. Date naturalizedN/A6. Naturalization certificate numberN/A7. Court issuing naturalization certificateN/A8. Issued at (City, State, Country)N/A9. If alien, give alien registration numberN/A10. Date and place of arrival in U.S.N/A11. Have you held previous nationality?* Yes* No12. If yes, give name of countryN/A13. Give particulars concerning previous naturalizationN/A14. Last U.S. visa (Number, type, place of issue)N/A15. Date visa issuedn/a### SECTION IVEDUCATIONELEMENTARY SCHOOL| 1. Name of elementary school | Address (City, State, Country) | Years attended (From - To) | Graduate || ---------------------------- | ------------------------------ | -------------------------- | :------: ||                              |                                |                            |   Yes    ||                              |                                |                            |    No    |HIGH SCHOOLS| 1. Name of high school | Address (City, State, Country) | Years attended (From - To) | Graduate || ---------------------- | ------------------------------ | -------------------------- | :------: ||                        |                                |                            |   Yes    ||                        |                                |                            |    No    || 2. Name of high school | Address (City, State, Country) | Years attended (From - To) | Graduate || ---------------------- | ------------------------------ | -------------------------- | :------: ||                        |                                |                            |   Yes    ||                        |                                |                            |    No    |COLLEGE OR UNIVERSITY STUDY| Name and location of college or university | Subject | Years attended | Degree   | Year     | Grade or Point Average | Number of Sem./Qtr. Hours (Specify) || ------------------------------------------ | ------- | -------------- | -------- | -------- | ---------------------- | ----------------------------------- ||                                            | Major   | From - To      | Received | Received |                        |                                     ||                                            | Minor   |                |          |          |                        |                                     ||                                            |         |                |          |          |                        |                                     |4. If a graduate degree has been noted above which required submission of a written thesis, indicate the title of the thesis and briefly describe its contentTRAPE, COMMERCIAL AND SPECIALIZED SCHOOLS|     | Name and address of school | Study or specialization | From | To  | No. of months || --- | -------------------------- | ----------------------- | ---- | --- | ------------- |
[104-10194-10026.pdf — page 274]
EDUCATION (Continued)MILITARY TRAINING IN SPECIALIZED SCHOOLS SUCH AS ORDNANCE, COMMUNICATIONS, ETC.| Name and address of school | Study or specialization | From | To  | No. of months || -------------------------- | ----------------------- | ---- | --- | ------------- ||                            |                         |      |     |               ||                            |                         |      |     |               ||                            |                         |      |     |               |Other education or training not indicated aboveSECTION VFOREIGN LANGUAGE ABILITIESList below the foreign language or languages in which you possess any degree of competence. Indicate your proficiency in each of the five skill factors shown (reading comprehension, writing ability, etc.) by noting the number most indicative of your level of skill under the factor being considered.If your proficiency relates to a particular dialect of a major language, identify this dialect by noting it in parentheses after the language on the same line.If you have no proficiency in any foreign language, check (X) box at right and leave other items blank.  [ ]|                    | (Slight) 1 | 2   | Level of Skill 3 | 4   | (Native) 5 |                    || ------------------ | ---------- | --- | ---------------- | --- | ---------- | ------------------ || SKILL FACTORS      |            |     |                  |     |            | HOW ACQUIRED       ||                    |            |     |                  |     |            | [Check (X) Box(es) ||                    |            |     |                  |     |            | which apply]       || Reading            |            |     |                  |     |            | Native or family   || comprehension      |            |     |                  |     |            |                    || Writing ability    |            |     |                  |     |            | Prolonged          ||                    |            |     |                  |     |            | residence          || Pronunciation      |            |     |                  |     |            |                    || Commercial ability |            |     |                  |     |            | Contact level      ||                    |            |     |                  |     |            | parents, etc.)     || Oral               |            |     |                  |     |            |                    || comprehension      |            |     |                  |     |            | Academic study     |2. If you have had experience as a translator, interpreter or instructor-explain and specify in which language(s) you have had such experience.3. Describe your ability to do specialized language work involving vocabularies and terminology in the scientific, engineering, telecommunications, military and other specialized fields.4. If you have noted a proficiency in language, would you be willing to use this ability in any position for which you might be selected? [ ] Yes  [ ] No(For Office Use Only)
[104-10194-10026.pdf — page 275]
# SECTION XI**MARITAL STATUS**1. Present status (Single, married, widowed, separated, divorced, annulled, remarried) specify: **Divorced**2. State date, place, and reason for all separation, divorce or annulment:   2-10-69, Juarez, Mexico, incompatibilityWife, husband or fiance(e)If you have been married more than once (including annulments) use separate sheet for former wife or husband giving date required below for all previous marriages. If marriage contemplated, fill in appropriate information for fiance(e).3. Name of spouse:   Phillips David Atlee4. State any other names ever used by spouse:   N/AIndicate circumstances (including length of time) under which any names noted in item 4 above were used. If legal change, give particulars (where and by what authority). Use extra space provided on pages 15 and 16 of this form to record this information.5. Date of birth:   10-31-226. Place of birth (City, State, Country):   Fort Worth, Texas7. Date of marriage:8. Place of marriage (City, State, Country):9. Living   Yes No10. Citizenship:    U.S.11. Former citizenship(s) (country(ies)):    N/A12. If alien, give alien registration number:    N/A13. Date U.S. citizenship acquired:    N/A14. Where acquired:    N/A15. Date and place of arrival in U.S.:    N/A16. Naturalization certificate number:    N/A17. Date of death:    N/A18. Cause of death:    N/A19. Current address (Give last address, if deceased):20. Address of spouse before marriage:21. Occupation:    Foreign Service Reserve Officer22. Present employer (Also give former employer, or if spouse deceased or unemployed, give last two employers):    U.S. Dept of State23. Employer's or business address (Number, Street, City, State, Country):    U.S. Dept. of State, Washington24. Dates of military service (From - to - by month & year):25. Branch of military service:26. Country with which military service affiliated:    U.S27. Details of other government service, U.S. or foreign:# SECTION XII**CHILDREN AND OTHER DEPENDENTS**1. Provide the following information for all children and dependents:| Name | Relationship | Date & Place of Birth | Citizenship | Address || ---- | ------------ | --------------------- | ----------- | ------- ||      |              |                       |             |         ||      |              |                       |             |         ||      |              |                       |             |         ||      |              |                       |             |         ||      |              |                       |             |         |2. No. of children (include step-children & adopted children) who are unmarried, under 21 years of age, and are NOT self-supporting:3. No. of other dependents (e.g., spouse, parents, stepparents, etc.) who depend on you for at least 50% of their support or children over 21 NOT self supporting:
[104-10194-10026.pdf — page 276]
SECTION XVII MOTHER-IN-LAW (If marriage contemplated, fill in information for future mother in law)1. Full name (Last - First - Middle - Maiden)2. State other names she has usedIndicate circumstances (including length of time) under which any names noted in Item 2 above were used. If legal change, give particulars (where and by what authority). Use extra space provided on pages 15 and 16 of this form to record this information.3. Date of birth4. Place of birth5. LivingYes ☐ No ☐6. Date of death7. Cause of death8. Citizenship (Country)9. Former citizenship(s) [country(ies)]10. Date U.S. citizenship acquired11. Where acquired (City, State, Country)12. Naturalization certificate number13. If alien, give alien registration number14. Date and place of arrival in U.S.15. Occupation16. Present employer (Give last employer if mother-in-law deceased or unemployed)17. Current address (Give last address, if deceased)SECTION XVIII RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (1) LIVE ABROAD, (2) ARE NOT U.S. CITIZENS OR (3) WORK FOR A FOREIGN GOVERNMENT1. Name (Last - First - Middle)2. Relationship3. Date of birth4. Place of birth (City, State, Country)Simmons, George Stuart Grandfathor 3-17-84 San Francisco, Calif5. Citizenship (Country)6. Address or country in which relative residesU.S.4143 Unterer Zielweg 111, Dornach, Switzerland7. Employed by8. Frequency of contact9. Date of last contactN/Anone19611. Name (Last - First - Middle)2. Relationship3. Date of birth4. Place of birth (City, State, Country)5. Citizenship (Country)6. Address or country in which relative resides7. Employed by8. Frequency of contact9. Date of last contact1. Name (Last - First - Middle)2. Relationship3. Date of birth4. Place of birth (City, State, Country)5. Citizenship (Country)6. Address or country in which relative resides7. Employed by8. Frequency of contact9. Date of last contactSECTION XIX RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO ARE IN THE MILITARY OR CIVIL SERVICE OF THE UNITED STATES1. Name (Last - First - Middle)2. Relationship3. Date of birth4. Place of birth (City, State, Country)5. Citizenship (Country)4. Address (Number, Street, City, State, Country)7. Type and location of service (If known)1. Name (Last - First - Middle)2. Relationship3. Date of birth4. Place of birth (City, State, Country)5. Citizenship (Country)6. Address (Number, Street, City, State, Country)7. Type and location of service (If known)1. Name (Last - First - Middle)2. Relationship3. Date of birth4. Place of birth (City, State, Country)5. Citizenship (Country)6. Address (Number, Street, City, State, Country)7. Type and location of service (If known)(For Office Use Only)--11--THIS SHEET MUST BE COMPLETED
[104-10194-10026.pdf — page 277]
SECTION XI MARITAL STATUS FORMER HUSBAND3. Ahorn, Thomas Joseph 21. Foreign Service Reserve   Officer4. N/A 22. U.S. Dept. of State5. 4-12-40 23. U.S. Dept. of State, Santo   Domingo, Washington, D.C.6. Washington, D.C.7. 4-6-59 24. N/A8. Hyattsvillo, Maryland 25. N/A9. yes 26. N/A10. U.S. 27. N/A11. N/A12. N/A13. N/A14. N/A15. N/A16. N/A17. N/A18. N/A19. U.S. Embassy, Santo Domingo, Dominican Republic20. 4622 Hunt Avenue, Chevy Chase, MarylandTHIS SHEET MUST BE COMPLETED
[104-10194-10026.pdf — page 280]
PHILLIPS DAVID A 1065 41SUBJECT: NOTIFICATION OF GRANTING OR OF REVOCATION OF CRYPTOGRAPHIC CLEARANCETHE ABOVE NAMES INDIVIDUAL (ITEM 1) HAS BEEN GRANTED A CRYPTOGRAPHIC CLEARANCE FOR THE CRYPTOGRAPHIC CLEARANCE HELD BY THIS INDIVIDUAL HAS BEEN REVOKED UNDER THE PROVISIONS OF HR 90-4. THE CLEARANCE (ITEM 2) OR REVOCATION (ITEM 4), IS EFFECTIVE AS OF THE MONTH AND YEAR SHOWN ABOVE. SUBJECT HAS BEEN BRIEFED OR DEBRIEFED AS APPROPRIATE: CONCERNING CRYPTOGRAPHIC AND RELATED COMMUNICATIONS SECURITY MATTERS AND HAS SIGNED A BRIEFING/DEBRIEFING STATEMENT, AS APPROPRIATE: ACKNOWLEDGING RESPONSIBILITY FOR THE PROTECTION OF CRYPTOGRAPHIC INFORMATION. UPON REVOCATION OF CRYPTOGRAPHIC CLEARANCE SUBJECT IS NOT AUTHORIZED TO HAVE CONTINUED CUSTODY OF, ACCESS TO, OR OTHERWISE GAIN FURTHER KNOWLEDGE OF STAFF CRYPTOGRAPHIC MATERIAL OR INFORMATION.WHEN EMPLOYEE NO LONGER REQUIRES THE CLEARANCE IN ORDER TO PERFORM HIS/HER ASSIGNED DUTIES, IT IS REQUESTED THAT THE COMMUNICATIONS SECURITY STAFF, OC. BE NOTIFIED THAT THE CLEARANCE MAY BE REVOKED.DISTRIBUTION:*   1 - EMPLOYEE'S COMPONENT (ITEM 3)*   1 - OFFICE OF PERSONNELDIRECTOR OF COMMUNICATIONS.FORM 597bCONFIDENTIAL
[104-10194-10026.pdf — page 281]
SECRET(When Filled In)# LANGUAGE PROFICIENCY AND AWARDS DATA1. PERSONNEL SERIAL NO (1-6)2.  I.D NO.3. NAME (7-24) LAST FIRST MIDDLE 4. OFFICE OR DIVISION 5. LANGUAGE 6. LANG. CODE (25-27)7. DATE OF TEST (46-51) 8 ANNIVERSARY DATE 9. GRADE 10. DATE OF BIRTH11. REASON FOR TAKING TEST12. TEST SCORESREADING (34) WRITING (35) PRONUNCIATION (36) SPEAKING (37) UNDERSTANDING (38)APPLY FOR AWARDESTABLISH SKILL LEVEL13. ELIGIBILITY (39) 14. TYPE OF AWARDA ACHIEVEMENT (A) ELEMENTARY (E) READING (R) SPEAKING (S) BASED ON TRAINING THAT WASM MAINTENANCE (M) HIGH (H) INTERMEDIATE (I) COMPREHENSIVE (C) DIRECTED (D) OR VOLUNTARY (V)NA15. INELIGIBLE (REASON)level of proficiency not maintained16 I CERTIFY THIS EMPLOYEE FOR A PROFICIENCY AWARD OF $SIGNATURE DATE (40-45)17 I CERTIFY THAT FUNDS ARE AVAILABLEOBLIGATION REF. NO. CHARGE ALLOTMENT NO.SIGNATUREFORM 1271 OBSOLETE PREVIOUS EDITIONS SECRET (10-45) MRD COPY5-60REMARKS