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# SECRET(When Filled in)## NOTIFICATION OF PERSONNEL ACTION1 SERIAL NUMBER1391342 NAME (LAST, FIRST, MIDDLE)FLORES DANIEL3 NATURE OF PERSONNEL ACTIONDESIGNATION AS PARTICIPANT IN CIA RETIREMENT AND DISABILITY SYSTEM4 EFFECTIVE DATEJUN 27 745 CATEGORY OF EMPLOYMENTREGULAR6 CSC OR OTHER LEGAL AUTHORITYPL 32-543 SECT. 2637 FAN AND NSCA4135 1594 118 FUNDS✓ TO Y□ TO YX□ TO CF□ TO CF□ TO CF9 ORGANIZATIONAL DESIGNATION10 LOCATION OF OFFICIAL STATIONDDO/HR DIVISIONLIMA, PERU11 POSITION TITLE12 POSITION NUMBER13 SERVICE DESIGNATIOND14 CLASSIFICATION SCHEDULE (YA, YB, etc.)15 OCCUPATIONAL SERIES16 GRADE AND STEP1217 SALARY OR RATE18 REMARKSEMPLOYEE WILL RECEIVE NOTIFICATION FROM THE DIRECTOR OF PERSONNEL OF THIS DESIGNATION, AND RIGHT OF APPEAL TO THE DIRECTOR OF CENTRAL INTELLIGENCE.SPACE BELOW FOR EXCLUSIVE USE OF THE OFFICE OF PERSONNEL|             19 ACTION Code              |  20 EMPLOYEE Code  |   21 SERVICE Code   |  22 STATION Code   |      23 SUPERVISOR Code       |     24 HOURS Code      | 25 DATE OF BIRTH | 26 DATE OF CHANGE | 27 DATE OF LEAVE || :-------------------------------------: | :----------------: | :-----------------: | :----------------: | :---------------------------: | :--------------------: | :--------------: | :---------------: | :--------------: ||                NTI/HARI                 |                    |                     |        COCA        |             COCA              |                        |                  |                   |                  ||                                         |                    |                     |                    |                               |                        |                  |                   |                  ||           28 RETIREMENT Data            | 29 SEPARATION Code | 30 RETIREMENT Data  | 31 LEAVE CATEGORY  | 32 Correction/Completion Date |  33 SECURITY REG. NO.  |      34 SEX      |                   |                  ||                                         |                    |                     |                    |                               |                        |                  |                   |                  ||                  Local                  |        Code        |        Local        |                    |                               |                        |                  |                   |                  ||                    2                    |                    |                     |                    |      **[DATA REMOVED]**       |                        |                  |                   |                  ||           35 VET. PREFERENCE            | 36 WORK COMP. Code | 37 LONG COMP. Date  | 38 CAREER CATEGORY |  39 FEDERAL/HEALTH INSURANCE  | 40 SOCIAL SECURITY NO. |                  |                   |                  ||                  11100                  |                    |                     |                    |             11100             |                        |                  |                   |                  ||                                         |                    |                     |                    |                               |                        |                  |                   |                  || 41 PREVIOUS CIVILIAN GOVERNMENT SERVICE | 42 LEAVE CAT. Code | 43 FEDERAL TAX Data | 44 STATE TAX Data  |                               |                        |                  |                   |                  ||                  11100                  |                    |                     |                    |                               |                        |                  |                   |                  ||                                         |                    |                     |                    |                               |                        |                  |                   |                  |SIGNATURE/DATE OF OTHER AUTHENTICATION![POSTED stamp]