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SECRET(When Filled In)# LANGUAGE PROFICIENCY AND AWARDS DATA| 1. PERSONNEL SERIAL NO.                                                 |                                                                                                      |                       |                                                                               || ----------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------- | --------------------- | ----------------------------------------------------------------------------- || 26105                                                                   |                                                                                                      |                       |                                                                               || 3. NAME (F 24) LAST                                                     | FIRST                                                                                                |                       |                                                                               || Richardson, Jacques G.                                                  |                                                                                                      |                       |                                                                               || 4. OFFICE OR DIVISION                                                   | 5. LANGUAGE                                                                                          | 6. LANG. CODE (25-27) |                                                                               || SR                                                                      | Seneca                                                                                               | 379                   |                                                                               || 7 DATE OF TEST (40-31)                                                  | 8 ANNIVERSARY DATE                                                                                   | 9. GRADE              | 10 DATE OF BIRTH                                                              || Jan. 5, 1960                                                            | Jan. 5, 1963                                                                                         | 14                    | Jan. 20, 1941                                                                 || 11 REASON FOR TAKING TEST                                               |                                                                                                      |                       |                                                                               || APPLY FOR AWARD                                                         |                                                                                                      |                       |                                                                               || ESTABLISH SKILL LEVEL                                                   |                                                                                                      |                       |                                                                               || 13 ELIGIBILITY (39)                                                     | 14 ACHIEVEMENT                                                                                       | (A) ELEMENTARY (E)    | 12. TEST SCORES                                                               || A                                                                       |                                                                                                      | INTERMEDIATE (I)      | READING (34) WRITING (35) PRONUNCIATION (36) SPEAKING (37) UNDERSTANDING (38) || M                                                                       | MAINTENANCE(M) HIGH(H)                                                                               |                       | -  -  1 1                                                                     || NA                                                                      |                                                                                                      |                       |                                                                               || 15 INELIGIBLE (REASON)                                                  |                                                                                                      |                       |                                                                               ||                                                                         | TYPE OF AWARD                                                                                        |                       |                                                                               ||                                                                         | READING (R) SPEAKING (S) COMPREHENSIVE (C)  BASED ON TRAINING THAT WAS DIRECTED (D) OR VOLUNTARY (V) |                       |                                                                               || 16. I CERTIFY THIS EMPLOYEE FOR A PROFICIENCY AWARD OF $ 100.00 (40-43) |                                                                                                      |                       |                                                                               || SIGNATURE DATE                                                          |                                                                                                      |                       |                                                                               || 17. I CERTIFY THAT FUNDS ARE AVAILABLE                                  |                                                                                                      |                       |                                                                               || OBLIGATION REF. NO. CHARGE ALLOTMENT NO.                                |                                                                                                      |                       |                                                                               || SIGNATURE                                                               |                                                                                                      |                       |                                                                               |REMARKSFORM 12735-60OBSOLETE PREVIOUSEDITIONSSECRET(10-45)TLO COPY