[104-10194-10022.pdf — page 115]
# STATEMENT OF PRIOR FEDERAL AND MILITARY SERVICEIMPORTANT: The information on this form will be used in determining creditable service for leave purposes and retention credits for reduction in force. The employee should complete Part I and the Personnel Office should complete Parte II through IV.PART L-EMPLOYEE'S STATEMENT1. NAME (Last, Arét, middle initian)   HIDALGO JA, BALMES NIEVIES2. DATE OF BIRTH   27 May 1919PART 11. THIS COLUMN IS FOR PERSONNEL OFFICE OSE9. RETENTION GROUP10. CSC STATUS (Five permanent employee only)YES NO3. LIST THE FOLLOWING INFORMATION CONCERNING ALL FEDERAL AND DISTRICT OF COLUMBIA SERVICE YOU HAVE HAD PRIOR TO YOUR PRESENT APPOINTMENTS (Do not include military service).| NAME AND LOCATION OF AGENCY | FROM-          | TO-            | TYPE OF APPOINTMENT I KNOWN | 11. SERVICE    || --------------------------- | -------------- | -------------- | --------------------------- | -------------- ||                             | YEAR MONTH DAY | YEAR MONTH DAY |                             | YEAR MONTH DAY || US ARMY DEPT OF DIESENSE    | 51 1 12        |                | Recent                      | 7 2 6          || QUARTERMASTER COD           |                |                |                             |                |4. LIST PERIODS OF SERVICE IN ANY BRANCH OF THE ARMED FORCES OF THE UNITED STATES. IF YOU HAD NO MILITARY SERVICE, WRITE "NONE"| BRANCH       | FROM-          | TO-            | DISCHARGE (Hon. of dishon.?) |        || ------------ | -------------- | -------------- | ---------------------------- | ------ ||              | YEAR MONTH DAY | YEAR MONTH DAY |                              |        || US ARMY INS- | 1939 MAR 27    | 43 SEPT 21     | HONIKAIK                     |        ||              |                |                |                              | 4 5 25 |5. DURING PERIOUS OF EMPLOYMENT SHOWN IN ITEM 3. DID YOU HAVE A TOTAL OF MORE THAN 6 MONTHS ABSENCE WITHOUT PAY, INCLUDING PERIODS OF MERCHANT MARINE SERVICE, DURING ANY ONE CALENDAR YEAR?YES NO12. TOTAL SERVICE    11 8 1IF ANGAER 15 "YES," LIST FOLLOWING INFORMATION.| TYPE IF KAN (LWOP, Purl, Susp, AWOL, Mor Mar) | FROM-          | TO-            | TOTAL             || --------------------------------------------- | -------------- | -------------- | ----------------- ||                                               | YEAR MONTH DAT | YEAR MONTH DAY | YEARS MOATHS DAYS |13. NONCREDITABLE SERVICE    (Leave pirposes only):14. NONCREDITABLE SERVICE    (RIF pisz pones only)6. DURING THE FEDERAL SERVICE LISTED IN ITEM 3, DID YOU ACQUIRE A PERMANENT COMPETITIVE CIVIL SERVICE STATUS?YES NO(If answer is "You," in what agency were you employed at the time status was acquired?)15. REEMPLOYMENT RIGHTS    YES NO7. ARE YOU:A. THE WIFE OF A DISABLED VETERAN?YES NO16. RETENTION RIGHTS    YES NOB. THE MOTHER OF A DECEASED OR DISABLED VETERANTYES NO17. EXPIRATION DATE OF RETENTION RIGHTSC. THE LAREMARRIED WIDOW OF A VETERANIYES NO8. ΤΟ ΕΕ ΕXECUTED 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.(DATE)(SIGNATURE)Subscribed and sworn to before we on this 13th day of Mar 1959 at Washington, D.C.(MONTH) (CITY) (STATE)SEALBetty A. BussardNOTE: If oath is taken before a Notary Public, the date of expiration of his Commission should be shown.(OVER)