HR- REQUEST FOR PERSONNEL ACTION

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 06942668
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 1
• Document Creation Date: July 23, 2025
• Document Release Date: July 31, 2025
• Publication Date: May 4, 1964

Approved for Release: 2025103124C06942668
(Whga Filled In);.
REQUEST FOR PERSONNEL ACTION
.,
DATE PREPARED
14117 Art
1. SERIAL NUMBER
2. NAME (Last-First-Middle) C., , --1,'
. ':,:. '
SIDIllaER Elizabeth
� - ,� ';,r,, 4. - 3
.1 ., ,;..t1...:Vr"I'.a : � -,.. ierr.
3. NATURE OF PERSONNEL ACTION
4. EFFECTIVE DATE RERUESTED ,�
5. CATEGORY OF EMPLOYMENT
_.
MONTH
5 .
., DAY ER.-
5-- - t
. .
, -
B. LEGAL AUTHORITY (Completed by OA* of,
Personnel) '
, ,, Ae-,-. .,-e.; rt.
9. ORGANIZATIONAL DESIGNATIONS
DrIP/NE
.
- ,
: . �� �
II.
PUbl DUN TITLE
13. CAREER SERVICE DESIGNATION
OPeratiems Ofpaler
D
14 CLASSIFICATIoN cruFnaii F (GC FR .4,- I
16 GRADE
AND STEP
17 SALARY OR RATE
GS
, 12/4
s.,.
$ ILI*TM
18. REMARKS
. _
i .
- - �� -
-, 'i - � ,-, � �rt ;�%-
18
DATE SIGNED ,
4 1%7,1964
.188. SIGNATURE,OF,CAREEE,DERVICE
-
APFROVING OFFICER ,
-----
..DATE,5.1GI�i419 .:��11!,1 _
I SPACE BELOW
FOR EXCLUSIVE USE
OF THE
OFFICE OF PERSONNEL
24. HOWE.
25. DATE OF BIRTH
26. DATE OF GRADE
27. DATE OF tEl
CODE
MO. DA. YR.
I I
MO. DA. YR.
I
MO. DA.
YR.
28. /ITE WIRE
29. SPECIAL
30. - � RETIREMENT
DATA
31. SEPARATION
32. CORREa1011/CANaUATION
DATA ,
� ,� . , , ..,
33. SECURITY,
34. SEX .
MO. DA. YR.
REFERENCE
1-CSC
3-FIU
CODE
DATA CODE
TYPE
MO. DA. YR.
EOD DATA
I I
5-NODE
I I
35. VET. PREFERENCE
36. SERV. CORP. DAM
37. LONG.
CORP. DATE
38. CAREER CATEGORY
39. _ , -�_. , FEGLI/HEA1.111 INSURANCE
40. SOCIAL SECURITY NO.
CODE
0-NONE
1-5 PT.
2-10 PT.
Mo. PA. YR.
I I
MO.
DA. YR.
I
CAR/R64
PROT/TEMP
CODE
CODE
0-WAIVER
1-9E5
HEALTH INS. CODE
,
41. PREVIOUS GOVERNMENT SERVICE DATA
42. LEAVE CAT.
43. FEDERAL TAX DATA
L
44. -STAR TAX DATA
CODE
0-NO PREVIOUS SERVICE
1-NO BREAK IN SERVICE
CODE.
FORM FORM EXECUTED
1-YES
CODE
NO. TAX EXEMPTIONS
FORM EXECUTED
1-YES
CODE
NO. TAX
STATE CODE
2-BREAM IN SERVICE (LESS THAN 3 YEARS)
3-41REAR IN SERVICE (MORE MAN 3 YEARS)
2-NO
45. POSITION CONTROL CERTIFICATION
DATE APPROVED
--
FORM
'
6_63 1152 USE PREVIOUS EDITION
GROUP 1
Iammo Air Diturtwari mums
Approved for Release: 2025/03/24 C06942668