[104-10225-10006.pdf — page 19]
# SECRETREQUEST FOR PERSONNEL ACTIONDate Prepared: 18 June 1974| 1 SERIAL NUMBER | 2 NAME (Last - First - Middle) || --------------- | ------------------------------ || 036130          | FLORES DANIEL                  |3 NATURE OF PERSONNEL ACTION:DESIGNATION AS A PARTICIPANT IN THECIA RETIREMENT AND DISABILITY SYSTEM| 4 EFFECTIVE DATE REQUESTED | 5 CATEGORY OF EMPLOYMENT || -------------------------- | ------------------------ || MONTH  DAY  YEAR           |                          || 06     23   74             | REGULAR                  || 6 FUNDS |         |        |         || ------- | ------- | ------ | ------- ||         | V TO V  | V TO V | V TO V  ||         | CP TO V | X      | CP TO V || 7 LEGAL AUTHORITY (Completed by Office of Personnel) || ---------------------------------------------------- || PL 88-643 SECT. 203                                  || 9 ORGANIZATIONAL DESIGNATIONS | 10 LOCATION OF OFFICIAL STATION || ----------------------------- | ------------------------------- || DDO/WH Division               | LIMA, Peru                      |11 POSITION TITLE12 POSITION NUMBER13 CAREER SERVICE DESIGNATIOND14 CLASSIFICATION SCHEDULE (GS, L.B. etc.)15 OCCUPATIONAL SERIES16 GRADE AND STEP1217 SALARY OR RATE$18 REMARKSEMPLOYEE WILL RECEIVE NOTIFICATION FROM THE DIRECTOR OF PERSONNEL OF THISDESIGNATION AND RIGHT OF APPEAL TO THE DIRECTOR OF CENTRAL INTELLIGENCE.18A SIGNATURE OF REQUESTING OFFICIALDATE SIGNED18B SIGNATURE OF CAREER SERVICE APPROVING OFFICERDATE SIGNEDSPACE BELOW FOR EXCLUSIVE USE OF THE OFFICE OF PERSONNEL| 19 ACTION CODE | 20 EMPLOYEE CODE | 21 OFFICE CODE | 22 STATION CODE | 23 EMPLOYEE STATUS | 24 NATURE OF ACTION | 25 DATE OF BIRTH/ CANCELLATION DATE | 26 DATE OF GRADE | 27 DATE OF LUI || -------------- | ---------------- | -------------- | --------------- | ------------------ | ------------------- | ----------------------------------- | ---------------- | -------------- ||                |                  |                |                 |                    |                     |                                     |                  |                || 53             |                  |                |                 | 3 080435           |                     |                                     |                  |                || 28 RETIREMENT DATE | 29 SERVICE COMPUTATION DATE | 30 RETIREMENT DATA | 31 SEPARATED CODE | 32 SEPARATION DATE | 33 SECURITY BADGE NO | 34 SEI || ------------------ | --------------------------- | ------------------ | ----------------- | ------------------ | -------------------- | ------ ||                    |                             | 2                  |                   |                    |                      |        |EOD DATA| 41  PREVIOUS RETIREMENT COVERAGE | 42  LEAVE CATEGORY | 43  RESERVE TAG NUMBER | 44 REINSTATEMENT INFORMATION | 45 SOCIAL SECURITY NO || -------------------------------- | ------------------ | ---------------------- | ---------------------------- | --------------------- ||                                  |                    |                        |                              |                       |See memo signed byBarbara Davis 6/4/74GK 6/4/74SECRET