NOMINEE CHECK LIST CIA RETIREMENT AND DISABILITY SYSTEM

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78-03092A000100070010-0
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 2
• Document Creation Date: December 9, 2016
• Document Release Date: May 14, 2001
• Sequence Number: 10
• Publication Date: May 6, 1965
• Content Type: FORM

Approved For Release 2001/07/28: CIOK 92A000100070010-0
NOMINEE CHECK LIST
CIA Retirement and Disability System
1. Name :
2. Age:
3. Service Designation: D
4. Years of Agency
Service: 16.10
5. Qualifying Service:
71
0
Months of qualifying service to date.
Subject performing qualifying service.
Subject certified under orders for qualifying
service assignment.
6. Service Agreement:
Gil
II
"Application for Membership in the Career Staff
of the CIA" to be used in lieu thereof.
Nominee is overseas - Service Agreement will be
requested when nomination approved.
. Date of 15th anniversary review
Fdrm
4-65 3100a (Test)
6 1965
6 MAY 1965
25X1A9a
Approved For Release 2001/07/28 :SEGET03092A000100070010-0
 25X1A
Approved For Release 2001/07/28 : CIA-RDP78-03092A000100070010-0
Approved For Release 2001/07/28 : CIA-RDP78-03092A000100070010-0