[104-10291-10000.pdf — page 35]
# SECRETREQUEST FOR PERSONNEL ACTIONDATE PREPARED: 17 September 19641. SERIAL NUMBER: 0179742. NAME: FOX, Jerome3. NATURE OF PERSONNEL ACTION:INTEGRATION--Dept of State6. FUNDS:*V* to VX to O9. ORGANIZATIONAL DESIGNATIONS: DDP/FE CS/CS27 Development Complement4. EFFECTIVE DATE REQUESTED:| MONTH | DAY | YEAR || ----- | --- | ---- || 9     | 18  | 64   |7. COST CENTER NO. CHARGE: 5137-139210. LOCATION OF OFFICIAL STATION: Washington, D. C.8. CATEGORY OF EMPLOYMENT: Regular9. LEGAL AUTHORITY (Completed by Office of Personnel)11. POSITION TITLE: Foreign Service Reserve Off Ops Off14. CLASSIFICATION SCHEDULE (G.S., W.M., etc.): FSR GS15. OCCUPATIONAL SERIES: 0136.0112. POSITION NUMBER: 929716. GRADE AND STEP:| 5   | 2   || --- | --- || 12  | 4   |13. CAREER SERVICE DESIGNATION: D17. SALARY OR RATE:$10,290$11,31518. REMARKSAll sick and All hours annual leave to be transferred to the Dept of StateMARITAL STATUS: MarriedDau - DOB: 22 Nov 59Training18A. SIGNATURE OF REQUESTING OFFICIAL:BeggostanE. Ervington, Cover Officer, X5013DATE SIGNED:18B. SIGNATURE OF CAREER SERVICE APPROVING OFFICER:DATE SIGNED:SPACE BELOW FOR EXCLUSIVE USE OF THE OFFICE OF PERSONNEL| 19. RETIRE 21. OFFICE CODING | 22. STATION 23. NUMERICAL | 23. NUMERICAL 24. DATE OF BIRTH 25. DATE OF GRADE 26. DATE OF LAST |     |      |          |     || ---------------------------- | ------------------------- | ------------------------------------------------------------------ | --- | ---- | -------- | --- || 55                           | 13                        | 13-907                                                             | FE  | 7302 | 10/09/28 |     ||---|---|---|---|---|---|---|| 28. WIT. LIP-CODE 29. SPECIAL | 30. RETIREMENT DATA | 31. SEPARATION | 32. CORRECTION/CANCELLATION DATA: |           || ----------------------------- | ------------------- | -------------- | --------------------------------- | --------- || DATA CODE                     |                     |                |                                   |           || 1 - W:                        | 2-S                 | 3 - C:         | MO. DA YR.                        | 101 09128 || 35. WIT. POS-PRES 36. SERV.COMP. DATE 37. LONG. COMP. DATE | 38. CAREER CATEGORY:      | 39. HElGHT-WEIGHT-INSURANCE: | 40. HEALTH INS. CODE | 41. PREVIOUS CIVIL SERVICE DATA: |     || ---------------------------------------------------------- | ------------------------- | ---------------------------- | -------------------- | -------------------------------- | --- || CODE                                                       | HEALTH INS. CODE          |                              |                      |                                  |     || CODE 0-DO FILTRMS 0-DO EXTRMS 1-3 P:                       | 1- TR/TEMP 2-PROV / TEMP: | 1-TR/TEMP 2-PROV / TEMP:     |                      |                                  |     || 42. LEAVE CAT:                                             | 43. FEDERAL TAX DATA:     | 44. STATE TAX DATA:          |                      |                                  |     |45. POSITION CONTROL CERTIFICATION![Signature] ZD Kickson 09/21/64NSC 1157 (REV. 4-63) NSA PREVIOUS EDITIONSECRET