14-00000 FP, assig res Coed citi C) ceranrannras CO) vs eccoby fan, | O8neecunter 1660 TAdrter ICI “SECTION & ~™ PERFORMANCE OF QUALIFYING SERVICE I, fos this employes campleted any qualifying service? flys im) en ft Tes”, Het poriods of such setvice below . ~ a ~~ | loa OND TOTAL iMG SECRET Ped fal pay yihen “NOMINATION AND DESIGNATION OF PARTICIPANT Cla RETIREMENT AMD OISABILITT SYSTEM SECTION A ; “STATUS OF EMPLOYEE aA TUS OF EMPLOTEE eee nen 23 280 S. AO wee CATEGORY wheter te Ko ostee Céreer Apert antec aE BEAL, MUMIAE "| 2, AME (pyape-Beret Vi sulel LF seve eee eee an materia yo - bow eee {7 anager BOF TICE OF AGSIGRMANT feyro}) n pe) é. CunAeNT 206 UPATIGNAL TITLE Oper. tion {tle and . bperttiona Giticer pequive MH TEC SE AVIS COME OTAT ION Le eee eee name ten mete meme eater new ne ds ' — oa . 10. LOU eT YY COMPUTATION ; Are se - ~—" i LOCAL weer te senvick Peter Coan Cl tly -Cluwetery ae State} ; ane erico City Pe LUsivE DATES (Fran- To) OCCUPATIONAL Tirta Pes “4 RAHAT A/D Aes ve Mose GAL Ry ,tey IMONT A DAYS et, 308 £6) preeert ~~ Gpere tions “Ofteer eo | | | ae ae y BCs TOY MONTHS DAYS . omployae wae Geeigned bes ‘the United States during any poriod of qualifying service listed above, describe his dutlos below, pointing out those sanditions which maet the requirements of QUALIFYING SERVICE, aualifying service? (Jv esft) NO NO. fe this employee curentiy un official ardews ine a PCS assignment requiring the performance oO H “Yes”, cttach ¢ certifecstion to this effect, Agoncy records, Where no oHizial recerd 5. CERTIFICATION . The information lorniehe! dabave has teen verified ageinet gHigiat wos available, ¢ supparting alotemont is attached 6. tvPZO: & ANG TITLE OF CARES “Te. au aT URE igscate APM Ih OP PICIAL | i Centinusd on Reverse Side ea" 3100 SECRET ret peas tae
SECRET fAhen Hy dled Bn} SECTION C STATUS OF SERVICE AGREEMENT [ OEE COVELL ILO BY CAGL LB GL EVICE APPS sitet, CECICTAL) Ra Form 3101, Servicn Ayaguast, iy Ptached, CT Because of temporury abserce of the nueminee, Form 3109, fearvice Agroamart, oti Le lurauidad ata tater date, C] {1) Nominee has over 14 ¢asee of Syarey sarelca of (7) nominee cannet he raxtity cantactad ta tiga » Service Apaommnt, The signad "&pnler steve bee Maesnbership in tha Career Staff of tha 6 14° 40 file in the nowineg's Olicial Personnel Falder seu be 3 stad in liew of Farm 3101, Service Apaexert, OQ Momines ie overtane aed a tignad “Aaulicutlun for Membershlpy in the Corear Tee af the CHA® ic HOT Filed In hie Official Parsonnol Futter, Fare ZION, Sarvice Agmamant, will be resuaatet beam the field upon natilication that the CIA Ketirement bowed bos racurmonded approval af his nomination, SECTION OD F, Based on his career aesignmant and gaer wid pruspective performance af qualifying serssea, this employee is racommended for ésvignation a6 a purticipunt in the CHA HE TIZE MENT AND DEILABHATY SYSTEM, Pa ie serving ina curaas Vield which caraiip caquicas the perlosmonce of aesisfgireg service as an inteyral part of o caress 16 The field, eee Gig ATURE © eo ia, DATE 2.77600 NAME AND TITLE 3, RUG HAT URE or HED “49 CAREER a service , Be CGuMENDATION OF CIA RETIREMENT ROALS SECTION € ; a f, The egrard of thia amployaa hoe bean  peeig wad ond the CIA RETIREMENT. DOAK hes reccenrmnd@d OR once mwe men {OATE) th this omployae: [7] be detignored os = pertictpent Ia the CIA RETIREMENT Aeru SHAULLITY SYST Esa ) HOS be designated a6 2 patichpan a a ee ne ne 2 PY NAME ANO PITRE . 2 SISHATURE 14, G*Te i I ' “GECTICN F DETETHiNATION BY DIRECTOR OF OF PERSONNEL curdanca with aqulation 29-05, thee anslagee is i2. 4 SRATURE GF Cibelli OF PEP. EMIGNATED a) HOT daeiqnsige a waerticipant in SOrdere te Tih Retliramant and Disability Syston. i% ’ _ DATE ee ADDITIONAL INF ORAA TION SECTICN G SECRET