[104-10225-10003.pdf — page 335]
# STATEMENT OF PRIOR FEDERAL CIVILIAN AND MILITARY SERVICE AND DETERMINATION OF COMPETITIVE STATUSIMPORTANT: The information on this form will be used (1) in determining creditable service for leave purposes and retention credits for reduction in force, and (2) in recording agency determination of competitive status. The employee should complete Part I and the Personnel Office should complete Parts II through V.PART 1 - EMPLOYEE'S STATEMENT1 NAME (Last, first, middle initial)Piccola, Joseph S.2 DATE OF BIRTH8 Dec 353 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.)| NAME AND LOCATION OF AGENCY | FROM           | TO             | TYPE OF APPOINTMENT IF KNOWN || --------------------------- | -------------- | -------------- | ---------------------------- ||                             | YEAR MONTH DAY | YEAR MONTH DAY |                              || F.B.I. Wash. DC.            | 53 Aug 8       | 55 Sept ?      |                              || C.I.A. Wash DC.             | 67 Feb 13      | 68 Oct 4       |                              |PART II - THIS COLUMN IS FOR PERSONNEL OFFICE USE9. RETENTION GROUP10. A. CSC STATUS YES NO    B. TYPE OF PRESENT APPOINTMENT11. SERVICE| YEAR | MONTH | DAY || ---- | ----- | --- ||      |       |     ||      |       |     |4. LIST PERIODS OF ACTIVE SERVICE IN ANY BRANCH OF THE ARMED FORCES OF THE UNITED STATES IF YOU HAD NO ACTIVE MILITARY SERVICE, WRITE "NONE"| BRANCH         | FROM           | TO             | DISCHARGE (Hon. or dishon?) || -------------- | -------------- | -------------- | --------------------------- ||                | YEAR MONTH DAY | YEAR MONTH DAY |                             || U.S. AIR FORCE | 6R Oct 1       | 62 Aug 24      | Hon.                        |5. DURING PERIODS 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 NO   IF ANSWER IS "YES," LIST FOLLOWING INFORMATION.| TYPE IF ABSENCE (LWOP, Furl, Susp, AWOL, Mil Mar) | FROM           | TO             | TOTAL             || ------------------------------------------------- | -------------- | -------------- | ----------------- ||                                                   | YEAR MONTH DAY | YEAR MONTH DAY | YEARS MONTHS DAYS ||                                                   |                |                |                   |12. TOTAL SERVICE13. NONCREDITABLE SERVICE (Leave purposes only):14. NONCREDITABLE SERVICE (RIF purposes only).6. DURING THE FEDERAL SERVICE LISTED IN ITEM 3, DID YOU ACQUIRE A PERMANENT COMPETITIVE CIVIL SERVICE STATUS!YES(If answer is "Yes," in what agency were you employed at the time status was acquired")CIA.15. REEMPLOYMENT RIGHTS YES NO16. RETENTION RIGHTS YES NO17. EXPIRATION DATE OF RETENTION RIGHTS7. ARE YOUA. THE WIFE OF A DISABLED VETERAN? YES NOB. THE MOTHER OF A DECEASED OR DISABLED VETERAN? YES NOC. THE UNREMARRIED WIDOW OF A VETERAN? YES NO8. TO BE EXECUTED BEFORE A NOTARY PUBLIC OR OTHER PERSONS AUTHORIZED TO ADMINISTER OATHSI swear (or affirm) that the above statements are true to the best of my knowledge and belief.27 August 1967Subscribed and sworn to before me on this 27 day of Aug 1967, at Danlius, Virginia![signature]David W HuberNOTE: If oath is taken before a Notary Public, the date of expiration of his Commission should be shownINSTRUCTIONS: File this form on the permanent side of the employee's official personnel folder immediately before or after the personnel action is completed.