SECRET (When Filled In) (foa-torts-t0tad] PERSONNEL ACTION REQUEST FOR 3. NATURE OF PERSONNEL ACTION Dis a Under CIA Retirerent § Disability 10, LOCATION OF OFFICIAL STATION 9. ORGANIZATIONAL DESIGNATIONS DDO/CI Staff Development Complement 12. POSITION NUMBER 11. POSITION TITLE Ops Officer 9997 14. CLASSIFICATION SCHEDULE (GS, LB, etc.) 15. OCCUPATIONAL SERIES 16. GRADE AND STEP 0136.01 13 7 GS 18. REMARKS Subject has been on Extended sick leave § Di Since 14 June 1972 d Security inance an DATE SIGNED F 22. STATION 23. INTEGREE 24. HOQTRS.) 25. CODE cove 19. ACTION | 20. EMPLOY. | 21. OFFICE CODING NUMERIC ALPHABETIC 31. SEPARATION RETIREMENT DATA DATA CODE Washington, D.C. isability retirement DATE PREPARED June 1973 8. LEGAL AUTHORITY (Completed by Office of Personnel) 13. CAREER SERVICE DESIGNATION 17. SALARY OR RATE 23,642 DATE OF BIRTH ann SECURITY REQ. §O. 40. SOCIAL SECURITY KO. 29, SPECIAL REFERENCE NTE EXPIRES 35, ver. PREFTRENE | [ 35. VET. PREFERENCE | PREFERERCE ; 38. CAREER CATEGORY “| ~ LEAVE CAT. | 43. rc | Lf | 37. LONG. COMP. DATE te 4a O—NO PREVIOUS SERVICE 36. SERV. COMP. DATE | YR. 1—5 FT. CODE _ 1—NO EREAK IN SERVIE 2—10 PT. 7 ‘ ; 2—BREAK IN SERVICE (LESS THAN 3 YEARS) | 3—BREAK IN SERVICE (MORE THAN 3 YEARS) 45. POSITION CONTROL CERTIFICATION PREVIOUS CIVILIAN _ SeRvice USE PREVIOUS EDITION SECRET FORM a-72 1152 1 CLASSIFIED ay, 01-0332 eS CAR/RESY CODE CODE | PROV / TEMP FEDERAL TAX DATA 44, STATE TAX DATA FoR EXECUTED, CODE NO. TAX EXEMPTIONS | FORM EXECUTED CODE [NO. TAX | STATE 1 YES 1 YES EXEMP, [CODE h 2—HO 2—-HO 2 s mamas oy 46. O.P. APPROVAL DATE APPROVED 4 Pa e- ‘§ 24 — 7 EX-2 +a. + ites
al RESIGN EFFECTIVE SECRET (Shen Filled In) EPAPLO YEE NGWICE OF RESIGNATION FOR THE FOLLOWING REASON: — MY LAST WORKING DAY WILL BE— SIGNATURE OF EMPLOYEE FORWARD COMMUNICATIONS, INCLUDING SALARY CHECKS AND BONDS, TO THE FOLLOWING ADDRESS (Number, Street, City, State, Zip Code) Items 1 thru 7 and Items 9 thru 18a) Item 5 — df z Trem 9 — ‘Items ll and 15 — Irem 18b — 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, not NOT to the current status of the -employee unless specific icems 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 ail levels of organization pertinent to identifying the location of the position: , 7 Major Component (Director, Deputy Director, etc.) Office, Major Staff, etc. Foreign Field or U.S. Field (éf pertinent) Division or Staff (subordinate to first line) Branch Section Unit “Position Title” and “Occupational Series” should be the standard abbreviated title and correspond- ing occupational series in Handbook of Official Occupational Titles and Codes for the duties actually to be performed by the employee. If different from the ticle and series of the position occu- pied as shown on the most current edition of the Position Control Register or Form 261, Stafiing 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 Service 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 Finance, one copy only will be seat co the Office(s) concerned. SECRET