. ‘ “fs oo - By 1 ie We Pe eke rai hfe o/: A “REQUEST FOR PERSONNEL ACTIONS: i 2. MAME ( Last First Middle) O'CONNELL, J. P., Jr. 1. SEMlAL PUMBER 8. LEGAL AUT Personnel) DDS/OFFICE OF SECURTYY DD/INVESTIGATIONS AND OPERATIONAL SUPPORT DFFICE OF THE CHIEF WASHINGTON, D. €. 12. POSITION NUMBER 13. CAREER SERVICE DESIGNATION SECURITY OFFICER 0522 14. CLASSIFICATION SCHEDULE (GS, LB, etc.) 13. OCCUPATIONAL SERIES 16. GRADE AND STEP 17. SALARY OR RATE cs 1810.01 Telephonic Concurrence, DOP/FE Personnel 13 August 1965. Date =, 8 AUG 1965 Security Approval been granted the ae contempla this requesh ice Cl. Br. TBA, SIGNATURE OF REQUESTING OFFICIAL Earned Herd Phie SPACE BELOW FOR EXCLUSIVE USE OF THE OFFICE OF PERSONNEL 19. ACTION | 20. EMPLOY. | 21. OFFICE CODING 22. SUATION 23. (MTEGREE 24. HDQTES./ 25. OATE GF SIRTH 26. DAVE OF GRADE @, BATE OF LE! (OBE CORE CODE 28. NTE EXPIRES «| 29. SPECIAL — | 30. «RETIREMENT DATA 31. SEPARATION | 37. CORRECTION /CANCELLATION DATA 33, SEORITY REF DATA CODE . RO. CREME Fe EOD DATA nfo 3—-AG $—BORE 35. VET. PREFERENCE 36. SERY. COMP. DATE 37. L086. COMP. DATE (38. CAREER CATEGORY . FEGLI /WEALTH (INSURANCE 40. SOUAL SECU! 6-~WONE UR /RESY WAIVER =$ FT. PROW /TEMP 1-15 210 FT. (Pere UGS 41. PREVIOUS GOVERNMENT SERVICE DATA 42, LEAVE CAT. | 43. FEDERAL TAX OATA O—HO PREVIOUS SERVICE (ove FORM EXECUTED FORM EXECUTED HO GREAK I SERVICE 1—¥ES 1-1 2—DREAK UH SERVICE (LESS THAR 3 YEARS) as 1-80 3—GREAK EW SERVICE (HORE THAN 9 YEARS) 43. POSITION CONTROL CERTIFICATION 46. ©O.P. APPROVAL g63 1152 use previous Eomon ‘ SECRET GROUP i (4; EXCLUDED SEGM AUTOMATIC BOWNGEADING 4 Aad GECLASSIFICATION
14-00000 (Biben Filled tn) EMPLOYEE NOTICE OF RESIGNATION I-RESIGN EFFECTIVE + wes a FOR THE FOLLOWING REASON: Bale (Date) egraund et. , (39 Not Reproduce * - e ees ore MY LAST WORKING DAY WILL BE DATE SIGNED SIGNATURE OF EMPLOYEE FORWARD COMMUNICATIONS, INCLUDING SALARY CHECKS AND BONDS, TO THE FOLLOWING ADORESS (Number, Sereet, City, State. Zip Code) Items 1 thru 7 and _ Items 9 thru 18a Item $ ~ Item 9 — FIRST INE Items 11 and 15 — Ikeem 18b — INSTRUCTIONS The initiating office should fill in each of the referenced items. Items 3 thru 7 and 9 thru 18 require information which: pertains only to the action requested, and NOT to the current status of the employee unless specific items remain unchanged. “Category of Employment” should show one of the following entries: Regular Summer WAE Part Time Detail Out Consultant Temporary ‘Detail In Military Temporary-Part Time “Organizational Designations” should show ai/ levels of organization pertinent to identify- ing the location of the position: Major Component (Director, Deputy Director, etc.) | Office, Major Staff, etc. Foreign Field or U.S. Field (sf pertinent) Division or Staff (subordinate to first line) Branch Section Unit “Position Title” and “Occupational Series” should be the standard abbreviated title and corresponding occupational series in Handbook of Official Occupational Titles and Codes for the duties actually to be performed by the employee. If different from the title and series of the position occupied as shown on the most current edition of the Position Con- trol Register or Form 261, Staffing Complement Change Authorization, explain under Item 18—Remarks. Signature should be that of the official authorized to approve for the Career Service to which the employee belongs. If more than one Career Service is involved, the gaining Career Serv- ice should approve and the other Career Service should concur in Item 18, Remarks. ROUTING— The original only of this form will be forwarded to the Office of Personnel through the appropriate Career Service official(s). In the case of requests specified in HB 20~-800-1, which require advance approval of or notification to the Office of Security or the Office of the Comptroller, one copy only will be sent to the Office(s) concerned. SECRET