[104-10224-10001.pdf — page 101]
# STANDARD FORM 144DEVISED SEPTEMBER 1964US CIVIL SERVICE COMMISSIONFPM CHAPTERS LI, AL AND 32STATEMENT OF PRIOR FEDERAL CIV AND MILITARY SERVICEAND DETERMINATION OF COMPETITIVE STATUSIMPORTANT: The information on this form will be used (1) in determining creditable service for leave purposes and retentioncredits for reduction in force, and (2) in recording agency determination of competitive status. The employeeshould complete Part I and the Personnel Office should complete Parts II through V.PART L-EMPLOYEE'S STATEMENT1. NAME (Last, First, middle initial)MAKSYMIEC MYROULAW A2.  DATE OF BIRTH30 APRIL 19473.  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.)PART II. THIS COLUMN ISFOR PERSONNEL OFFICE USE9. RETENTION GROUP10. A. CIC STATUS YES NOO. TYPE OF PRESENTAPPOINTMENT| NAME AND LOCATION OF AGENCY | FROM-          | TO-            | TYPE OF APPOINTMENT IF KNOWN | 11. SERVICE    |     |     || --------------------------- | -------------- | -------------- | ---------------------------- | -------------- | --- | --- ||                             | YEAR MONTH DAY | YEAR MONTH DAY |                              | YEAR MONTH DAY |     |     ||                             |                |                |                              |                |     |     |4: LIST PERIODS OF ACTIVE SERVICE IN ANY BRANCH OF THE ARMED FORCES OF THE UNITED STATES. IF YOU HAD NO ACTIVEMILITARY SERVICE, WRITE "NONE"| BRANCH  | FROM-       | TO-          | DISCHARGE (Hon. or dishon.?) || ------- | ----------- | ------------ | ---------------------------- || US ARMY | 194/ FEB 25 | 196/ July 31 | HON.                         |5. DURING PERIODS OF EMPLOYMENT SHOWN IN ITEM 3. DID YOU HAVE A TOTAL OF MORE THAN 6 MONTHS ABSENCE 12. TOTAL SERVICE   WITHOUT PAY, INCLUDING PERIODS OF MERCHANT MARINE SERVICE, DURING ANY ONE CALENDAR YEAR? YES NO   IF 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 ||                                                 |                |                |                    |13. NONCREDITABLE SERVICE    (Leave purposes only):14. NONCREDITABLE SERVICE    (RIP purposes only):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?)15. REEMPLOYMENT RIGHTS    YES NO7. 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 VETERANT YES NO16. RETENTION RIGHTS    YES NO17. EXPIRATION DATE OF RETEN-    TION RIGHTS8. 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.27 Nov 1961(DATE)(SIGNATURE),Subscribed and sworn to before me on this 27 day of Nov 1961 at Washington D.C(MONTH)(CITY)(STATE)SEALNOTE: 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 personnelaction involved.(OVER)