CANCELLATION OF APPLICANT PROCESSING

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP80-00679A000100010116-8
• Release Decision: RIFPUB
• Original Classification: S
• Document Page Count: 1
• Document Creation Date: November 17, 2016
• Document Release Date: July 12, 2000
• Sequence Number: 116
• Content Type: FORM

Approved For Re%ais 2000IO8/16 : CIA-RDP80-OO AQ001- 0116-8
SECRET
--Security--Information
1. ci.itllr;iLRett L.& UI ur arr1.~,Lliiuwi .t'tLtA~ 7 ,ii u -- - - - -
f 2U Name (last, first, middle) 3- Security request no. & date
Position title and grade 5, Office (division, branch)
Clearance= S _ 7 Date security clearance granted
a. Types of clearance requested
ba Type of clearance granted at Date of of cancellation
-0~ time of cancellation if any
.1 P I- To be ta proy'. sonaearance was reques
a < was app. icanv. emp.Loyea at time Yes No b , If yes p city Sty
'Ca
do z? (check one) where?
C Accepted another position C 1 Did not want overseas
aC Returned to school Not interested in Washington, D, C
L -o not reply to correspondence C-1 To enter military service
=1 Desired to remain in present position t J Office no longer interested
CJ Wa tted higher grade CJ Security disapproval
C Not interested (general) = Cancellation advised by T&S
C:--' Declining because of family CZ1 Medical disapproval
C To be married E-11 Other (specify in remarks)
' Uzr val fable no-? ma be ava.i m later CTJ to reason iven
ri A179S:3 '.V r
It O Signature
Form No (Previous editions DIST. [~PPi} 2 JM Br. fiOpr,. Off,
Feb a 1,953 - 7~ 9 not to be used) SECRET CJ RPS 01M DMedG Off <
Original and 6 copies (snap-out form)
Approved For Release 2000/08/16 : CIA-RDP80-00679A000100010116-8