IEG PERSONNEL RECORD

• Document Type: CREST
• Collection: NGA Records (Formerly NIMA)
• Document Number (FOIA) /ESDN (CREST): CIA-RDP73T00325R000100080015-9
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 4
• Document Creation Date: December 28, 2016
• Document Release Date: June 9, 2008
• Sequence Number: 15
• Content Type: FORM

Approved For Release 2008/06/09: CIA-RDP73T00325R000100080015-9
EMERGENCY ADDRESSEE
TELEPHONE
BIRTH DATE )00-
R A D E
F ssw '
DATE
Approved For Release 2008/06/09: CIA-RDP73T00325R000100080015-9
 Approved For Release 2008/06/09: CIA-RDP73T00325R000100080015-9
EDUCATION:
Degree Subject
College/University Date
SUPPLEMENTARY TRAINING:
Course Name Source Grade Date
Approved For Release 2008/06/09: CIA-RDP73T00325R000100080015-9
 Approved For Release 2008/06/09: CIA-RDP73T00325R000100080015-9
/f' 6i i -/~C- (/ -7n)
SECRET
(When Filled In)
IEG
PERSONNEL RECORD
EOD CIA DIA
OD NPIC
EOD
IEG
SERIAL NO.
PROMOTION RECORD
(TITLE/SLOT/GRADE/DATE)
DIVISION/BRANCH
DIA/CIA BADGE NO.
BUILDING BADGE NO.
SOCIAL SECURITY NO. _
DEGREES AND OTHER COLLEGE COURSES APPLICABLE EXPERIENCE
MILITARY
BRANCH OF SERVICE
RANK-DATE OF RANK
ACTIVE DUTY DATES
RESERVES (ACTIVE)
DATE AND PLACE OF
BIRTH
EMERGENCY ADDRESS
MARITAL STATUS
HOME PHONE
HOME ADDRESS
EXTENSION ROOM
Approved For Release 2008/06/09:
CIA-RDP73T00325R000100080015-9
 Approved For Release 2008/06/09: CIA-RDP73T00325R000100080015-9
Serial No. Name of Employee (Lost-First-Middle) Office Room No. Building
Office Telephone Cigy. Info. Data
FhVA~ 1
Homo Address Nurriltor, 51 at, L r~ 'f)
la I na Tolo rhono Number
Nome of Emorgondj!Dosignoo
Relationship
Dosignoo'sHomo Tel. No.
,GL
pE9
Emergoncy Designee's Home Address (Number.. Street, City, State)
Code
Designee Wi ring of
$
Agency Employment
1-Yos 2-No 3-Agency Employed
DO NOT EDIT, ERASE OR WRITE-IN INFORMATION IN THE SPACE ABOVE
9
TO REPORT CHANGES & ADDITIONS, USE ONLY THE ITEMS BELOW. LEAVE UNCHANGED ITEMS BLANK (Rotor to Handbook 20.7)
N
M
1. Serial No.
2. . Na me of Employee (loH?Flrst?Middb)
3. OfFico/Division Room No. Building Office Telephone
m
4. Homo Address (Number, Street, City, State) IF. ASSIONED KS ABROAD, NOTE MAILING ADDRESS
4a. Zipcodo
5. Homo Telephone No.
6. Name of Emergency Designee
7. Relationship
8. Is Designee Witting of
9. Is Dosignoe Employed
Your Agency Employment?
by Agency?
^ Yas F1 No
^ Yes ^ No
O. Emergency Designee's Address (Number, Street, City, State) SL?L PAR. Jr OF HI/U 20-7
11. Designee's Telephone No.
12.
13. Remarks
]TIiUMBER
14.-Signature of Approving Officer
Refer to Handbook 20-7 for Definition
Obso'^to Previous 5. ? .~ r"'E?;,.?,
FORM 642
967 1Gion PERSONNEL EMERGEN4.AAND LOCATOR RECORD':
`
Approved For Release 2008/06/09: CIA-RDP73T00325R000100080015-9