REQUEST FOR PERSONNEL ACTION FOR PHILLIPS, DAVID A.
Originator: CIA
Document date: 01/02/1970
Document type: PAPER - TEXTUAL DOCUMENT

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104-10128-10260

2022 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992

SECRET

(When Filled In)

DATE PREPARED

REQUEST FOR PERSONNEL ACTION

2 January 19%0

1. SERIAL NUMBER

12. NAME (LaSt-First-Middle)

024345

3. NATURE OF PERSONNEL ACTION

PHILLIPS, DAVID A.

6. FUNDS

REASSIGNMENT

V TO V

CF TO V

V TO CF

OF TO CF

1. EFFECTIVE DATE REQUESTED

MONTH

DAY

YEAR

01

7. FINANCIAL

ENARCALLANALYSIS NO.

0135 0694

10. LOCATION OF OFFICIAL STATION

S. CATEGORY OF EMPLOYMENT

REGULAR

8. LEGON AUTHORITY (Completed by Office of

9. ORGANIZATIONAL DESIGNATIONS

DDP/WH

FOREIGN FIELD

BRANCH 5

16-20

RIO DE JANEIRO, BRAZIL STATION

11. POSITION TITLE

12. POSITION NUMBER

ISt SECRETARY, POLITICAL OFFICER

0186

14. CLASSIFICATION SCHEDULE (GS, L.B, esc.)

15. OCCUPATIONAL SERIES

16. GRADE AND STEP

ESR

03 7

18. REMARKS GS

0136.05

164

FROM: DDP/WE/COG/OFF OF THE CH/POS #1105

HOME BASE WH

APPROVED 259a attached

16-20

PS. CARELA SERVICE BESIGMATIK

D

17. SALARY OR RATEC!

23,646..

5017, 5191

1 - Finance

2 - Security

18A. SIGNATURE OF REQUESTING OFFICIAL

DATE SIGNED

18B. SIGNATURE OF CAREER SERVICE APPROVING OFFICER

HENRY L.

BERTHOLD

C/HE/Pers

SPACE BELOW FOR EXCLUSIVE USE OF THE OFFICE OF PERSONNEL

19. ACTION |20. EMPLOY. 21.

CODE

CODE

OFFICE CODING

NUMERIC

ALPHABETIC

22. STATION

23. INTEGREE

24. MOQTES. 25. DATE OF BIRTH

то.

DA.

YR.

26. DATE OF GRADE

мо.

DA.

TR.

DATE SIGNED

27.

но.

DATE OF LEI

DA.

YR.

28.

мо.

NTE EXPIRES

DA.

vR.

29. SPECIAL

REFERENCE

30.

TEST

RETIREMENT DATA

2-ORGN

CODE

- B-NONE

26. BEN. COME DATE

37. LONG. COMP. DATE

31. SEPARATION

DATA CODE

32. CORRECTION/ CANCELLATION DATA

TYPE

мо.

DA.

VR.

33. SECURITY

REQ. MO.

34. SEX

EOD DATA

35. VET. PREFEREMCE

CODE

I-S MT.

2-10 М.

11.

CODE

PREVIOUS CIVILIAN GOVERMMENY SERVICE

O- NO PREVIOUS SERVICE

1-NO BREAK IN SERVICE

-BREAX IN SERVICE (LESS THAN 3 YEA

-BREAX IN SERVICE (MORE THAN 3 YEA

45. POSITION CONTROL CERTITICATION

| 38.

• CAREER CATEGORY

CAR /RESY

CODE

PROV/TEMP

39.

CODE

O- WAIVER

1- YES

FEGLI /HEALTH INSURANCE

HEALTH INS. CODE

40. SOCIAL SECURITY MO.

42. LEAVE CAT. 43.

FEDERAL TAX DATA

CODE

FORM EXECUTED | CODE

NO. TAX EXEMPTIONS

I-YES

2-N0

44.

FORM EXECUTED

STATE TAX DATA

CODE NOMAX STATE CODE

16. O.P. APPROY RETURN TO CIA

Background Use Only

Do Not Roproduce

DATE APPROVED

ORM 115

-671

USE PREVIOUS EDITION

SECRET

(4)

GROUP

UTOMATI

EXCLUDED ERO DEGASSHTA HOMNGRADING

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•*

I RESIGN EFFECTIVE

SECRET

(When Filled In)

EMPLOYEE NOTIGE OF RESIGNATION

_ FOR THE FOLLOWING REASON:

(Dase)

MY LAST WORKING DAY WILL BE-

DATE SIGNED

SIGNATURE OF EMPLOYEE

FORWARD COMMUNICATIONS, INCLUDING SALARY CHECKS AND BONDS, TO THE FOLLOWING ADDRESS (Number, Strees, Ciey, State, Zip Code)

INSTRUCTIONS

Items 1 thru 7

and

Items 9 thru 18a)

Item 5 - "Category of Employment" should show one of the following entries:

Regular

Summer

Part Time

Detail Out

Temporary

Detail In

Temporary-Part Time

WAE

Consultant

Military

Item 9 - "Organizational Designations" should show all levels of organization pertinent to identify-

ing the location of the position:

FIRST

Major Component (Director, Deputy Director, etc.)

Office, Major Staff, etc.

Foreign Field or U.S. Field (if pertinent)

Division or Staff (subordinate to first line)

Branch

Section

Unit

Items 11 and 15 - "Position Title" and "Occupational Series" should be the standard abbreviated title and

or the dies accution pier in Hand the employcial Of dificione from the title and

series of the position occupiec

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.

Item 18b - Signature should be that of the official authorized to approve for the Career Service to which

che employee belongs. If more than one Career Service is involved, the gaming Career serve

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

In the case of requests specified in HB 20-800-1, which require advance

apper sevice nocitcarion to the Office ol Security or the Office of Finance, one copy only will

SECRET

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