[104-10224-10008.pdf — page 154]
# STATEMENT OF PRIOR FEDERAL CIVILIAN AND MILITARY SERVICEIMPORTANT: This form is used only to establish creditability of service, which is otherwise not verified in the Official Personnel Folder, for leave and reduction in force purposes. The employee will complete Part I and the Personnel Office Parts II and III. When this form is used as a cumulative record or the employee's affidavit is used in the absence of a certified record, it must be filed on the right side of the Official Personnel Folder.PART I - EMPLOYEE'S STATEMENT1. NAME (Last, first, initial)MUNRO, GEORGE F.2. BIRTH DATE (Mo., Day, Yr.)8/21/153. LIST THE FOLLOWING INFORMATION ABOUT ANY CLAIMED FEDERAL OR DISTRICT OF COLUMBIA SERVICE YOU HAVE HAD WHICH HAS NOT YET BEEN VERIFIED (Do not include military service.) IF *ANY* OF THIS SERVICE WAS PART-TIME, WAE, OR INTERMITTENT, NOTE THIS UNDER "TYPE OF APPOINTMENT."| NAME AND LOCATION OF AGENCY     | FROM           | TO             | TYPE OF APPOINTMENT (If known) || ------------------------------- | -------------- | -------------- | ------------------------------ ||                                 | YEAR MONTH DAY | YEAR MONTH DAY |                                || FEDERAL BUREAU OF INVESTIGATION | 40   8    2    | 60   10   31   | SPECIAL AGENT                  || CIA                             | 60   11   1    | PRESENT        | CAREER ASST                    |4. LIST PERIODS OF ANY CLAIMED ACTIVE SERVICE YOU HAVE HAD IN ANY BRANCH OF THE ARMED FORCES OF THE UNITED STATES, INCLUDING ACTIVE DUTY AS A RESERVIST, WHICH HAS NOT YET BEEN VERIFIED. (Also list Merchant Marine service, if it interrupted service shown in Item 3.)| BRANCH                                                                  | FROM           | TO             | DISCHARGE (Hon. or Other) || ----------------------------------------------------------------------- | -------------- | -------------- | ------------------------- ||                                                                         | YEAR MONTH DAY | YEAR MONTH DAY |                           || US ARMY (2nd. Lt., 30th U.S. Inf., Presidio, San Francisco, California) | 39   10   25   | 40   7    31   | HONORABLE                 |5. DURING PERIODS OF EMPLOYMENT SHOWN IN ITEM 3, DID YOU HAVE A TOTAL OF MORE THAN 6 MONTHS ASSENCE WITHOUT PAY DURING ANY ONE CALENDAR YEAR? (If YES, list following information.)| TYPE IF KNOWN (L.W.O.P., Furl., Susp., A.W.O.L) | FROM           | TO             | TOTAL            || ----------------------------------------------- | -------------- | -------------- | ---------------- ||                                                 | YEAR MONTH DAY | YEAR MONTH DAY | YEARS MONTH DAYS || No                                              |                |                |                  |6. DO YOU CLAIM ANY TYPE OF VETERAN PREFERENCE WHICH HAS NOT BEEN VERIFIED? X *No* If "Yes", check one of the following statements if it applies to you:  * CLAIM PREFERENCE AS THE WIFE OF A DISABLED VETERAN.  * CLAIM PREFERENCE AS THE MOTHER OF A DECEASED OR DISABLED VETERAN.  * CLAIM PREFERENCE AS THE UNREMARRIED WIDOW OF A VETERAN.7. 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.Date: 7-5,May, 1969.Subscribed and sworn to (or affirmed) before me on this ________ day of _________ 19 ____.(Month)(Signature)(City)(State)SEALNOTE: If oath is taken before a Notary Public, the date of expiration of his Commission must be shown.