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SECRET# REQUEST FOR PERSONNEL ACTION1 SERIAL NUMBER0243452 NAME (Last-First- Middle)PHILLIPS, DAVID A.3 NATURE OF PERSONNEL ACTIONDESIGNATION AS A PARTICIPANT IN THE CIA RETIREMENT AND DISABILITY SYSTEM4 EFFECTIVE DATE REQUESTEDMONTH DAY YEAR10 23 665 CATEGORY OF EMPLOYMENTREGULAR6 FUNDSV TO VV TO CF7. FINANCIAL ANALYSIS NO CHARGEABLE8 LEGAL AUTHORITY (Completed by Office of Personnel)PL 88-643 Sect. 203CF TO VXCF TO CF9 ORGANIZATIONAL DESIGNATIONS7135-087510 LOCATION OF OFFICIAL STATIONDDP/WH11 POSITION TITLESANTO DOMINGO, DOMINICAN REPUBLIC12 POSITION NUMBER13. CAREER SERVICE DESIGNATIOND14. CLASSIFICATION SCHEDULE (GS, LB etc.)15 OCCUPATIONAL SERIES16 GRADE AND STEP1517 SALARY OR RATE$18 REMARKSEMPLOYEE WILL RECEIVE NOTIFICATION FROM THE DIRECTOR OF PERSONNEL OF THIS DESIGNATION AND RIGHT OF APPEAL TO THE DIRECTOR OF CENTRAL INTELLIGENCE.18A SIGNATURE OF REQUESTING OFFICIALDATE SIGNED18B SIGNATURE OF CAREER SERVICE APPROVING OFFICERDATE SIGNEDSPACE BELOW FOR EXCLUSIVE USE OF THE OFFICE OF PERSONNEL| 19 ACTION CODE                                                                                        | 20 EMPLOY CODE             | 21 OFFICE CODING NUMERIC               | 22 STATION CODE ALPHABETIC                             | 23 INTEGREE CODE                               | 24 MOOTES CODE        | 25 DATE OF BIRTH MO DA YR | 26 DATE OF GRADE MO DA YR | 27 DATE OF LEI MO DA YR || ----------------------------------------------------------------------------------------------------- | -------------------------- | -------------------------------------- | ------------------------------------------------------ | ---------------------------------------------- | --------------------- | ------------------------- | ------------------------- | ----------------------- || 28 NTE EXPIRES                                                                                        | 29 SPECIAL REFERENCE       | 30 RETIREMENT DATA CODE                | 31 SEPARATION DATA CODE                                | 32 CORRELATION CANCELLATION DATA TYPE MO DA YR | 33 SECURITY REQ NO    | 34 SEX                    |                           |                         || 0                                                                                                     | CA                         | 1-LSC 3-FEA 5-NONE 2                   |                                                        |                                                | EOD DATA              |                           |                           |                         || 35 VET PREFERENCE CODE                                                                                | 36 SERV COMP DATE MO DA YR | 37 LONG COMP DATE MO DA YR             | 38 CAREER CATEGORY CODE                                | 39 REGL HEALTH INSURANCE CODE                  | 40 SOCIAL SECURITY NO |                           |                           |                         || 0-NONE 1-5 PT 2-10 PT                                                                                 |                            |                                        |                                                        | 0-WAIVER 1-YES                                 |                       |                           |                           |                         || 41 PREVIOUS CIVILIAN GOVERNMENT SERVICE CODE                                                          | 42 LEAVE CAT CODE          | 43 FEDERAL TAR DATA CODE FORM EXECUTED | 44 STATE TAR DATA CODE NO TAR EXEMPTIONS FORM EXECUTED |                                                |                       |                           |                           |                         || 1-NO PREVIOUS SERVICE 2- BREAK IN SERVICE (LESS THAN 3 YEARS) 3- BREAK IN SERVICE (MORE THAN 3 YEARS) | 1-YES 2-NO                 |                                        | 1-YES 2-NO                                             |                                                |                       |                           |                           |                         |45 POSITION CONTROL CERTIFICATION10-1300-NSee memo signed by D/Pers dated 10, 1966FORM 1152 USE PREVIOUS EDITIONCP.4.7.66