CONTRACT INFORMATION AND CHECK LIST - MILLS, MONTRELL EUGENE

• Document Type: FOIA
• Keywords: MILLS MONTRELL E
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0001308893
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 2
• Document Release Date: February 19, 2008
• Case Number: F-2005-00558
• Publication Date: March 10, 1966

 CONTRACT INFORMATION AND CHECK LIST ~ "G1810N C SE OFFICER `eur"i'ty ~NSTI~UCTIOf~'~: Uae         for guidance. t t I - TELEPHONE EXTENSION DATE tems,   nger   n         w Pn   ems pre no qqp s a 44mp S plica  e. Forward or g na     end  WO co tee   for  reparetton to March 1 66 9 of contrec SECTION I                                  GENERAL I. NAME 2A. PROJECT 9. ALLOTMENT N0. 4. SLO~ 2B. PERMANENT STATION 9A.   FUNDS 5. PREVIOUS CIA 8. INDIVIDUAL HAS BEEN ENGAGED BV CIA OR ITS ALLIED ACTIVITIES IN SOME CAPACITY PRIOR TO THIS CONTRACT.  ?   YES   O  No  (If yea, describe and Include dates and salary.) NONE 28 March 1  1 to Present  Staff Employee )$l  oLS~ 7. SECURITY CLEARANCE (Type end date) 7A.        MEDICAL CLEARANCE 8. CONTRACT IS TO BE WRITTEN " .t OBTAINED     INITIATED         NOT REO'D. YEe      NO I.E., "U.S. GOVERNMENT 9. INDIVIDUAL WILL WORK UNDER "CONTROLLED CONDITIONS" I.E., REGULAR OFFICE 10. PROPOSED CATEGORY (~ HOURS AWAY FROM SUBJECT'S HOME AND PERFORMED UNDER THE SUPERVISION OF A eonlract employee, sta.) STAFF EMPLOYEE   D                                            r~I  YE9          ~ ND I,~J Staff  ~  ant PERSONAL DATA SECTION II 11. CITIZENSHIP 12. IF NOT U.S. CITIZEN, INDIVIDUAL IS A PERMA? 19. AGE 14. DATE OF BIRTH (Month, day, year) . NENT RESIDENT ALIEN  Q  YEe          ?  xo 2}2 31 Jan 192+ RESIDENCE (City end etete or country) 15. LEGAL 18. CURRENT RESIDENCE (City end etete or country) Falls Church  Vir inia 2626 Sigmona St, Falls Church, Va. 17. MARITAL STATUS (Check as appropriate) SINOL[     ~ MARRIED       Q    WIDOWLD            O   ANNULLED   Q  SEPARATED        ~ OIYORCED 19. NUNBER OF DEPENDENTS (Not Inciuding lndlviduel) 19. INDIVIDUAL IS RELATED TO A STAFF EMPLOYEE,             OR RELATIONSHIP AND AGEi AN INDIVIDUAL CURRENTLY   RKING FOR THE A -~   CAPACITY   ~ YEe     ~ x0 1' Marjorie  -Wife  -Age            'tl RELATIONSHIPS Jeffory - Son- Age 21 Thomas - Son - Age 13 Robert - Son - Age 10 SECTION III                                     U.S. MILITARY STATUS 20. RESERVE 21. VETERAN 22. IF RETIRED, INDICATE CATEGORY (Longevity, combat dls- ebillty, service dieablllty non-combat) Ye S 29. BRANCH OF SERVICE E 24. RANK OR GR AD 2b. DRAFT ELIGIBLE 28. DRAFT DEFERMENT OBTAINED T ~ lst?  Lt? ~  YE9       ~ NO BY  CIA  ~ YEe      ~  NO SECTION IV                                        COMPENSATION 27. BASIC SALARY 28. POST DIFFERENTIAL 29.~ (Breakdown, !f any) 90. FEDERAL TAX WITHHOLDING GS-13 Step 5 ~G.+f.,~SD NONE NONE YES YES NO NO SECTION V                 ALLOWANCES (NORMALLY ORANTRD ONLY TO RBSIDRNTS OF TN& UNITSD STATRS) 91. QUARTERS 92. POST 89. OTHER NONE NONE NONE 94.   0(Break down, if any) NONE SECTION VI                                      TRAVEL 93. TYPES 98. WtTN DEPENDENTS O    PCS         DOMESTIC OPERATIONAL        ~FOREIBN OPERATIONAL O    YE!  ~  NO 97.     HHE TO BE SHIPPED 97A.     HHE TO BE STORED 99. PERSONAL VEHICLE TO BE SHIPPED 99.    E  CLE USED FOR OPERATIONAL TRAVEL YES            NO YES           NO YE9               NO YES    NO 40. IF WITH DEPENDENTS STATE RELATIONSHIP, CITIZENSHIP, AGE AND DATE OF BIRTH NA APPROVED FOR RELEASE DATE: NOV 2007 41. PAYMENT AND ACCOUNTABILIT  WILL BE IN CONFORMANCE WITH CIA REDULATIONS            O         POLICIES AND PROCEDURES SECTION VII                                          OPERATIONAL EXPENSES 42. PURCHASE OF INFORMATION 48. ENTERTAINMENT 44. OTHER S   ET CONTRACT INFORMATION AND CHECK LIST DIVISION Securi (CONTINUED)                            T NOT/i'r   SSR INSTRUCTIONS ON PIRST SNBBT. ELEP 0 E EX TENSION DATE 10 March  1966             ? SECTION VIII                                       OTHER BENEFITS 48. BENEFITS                                                                             end/or succeaaor reg uletlona for beneflta epp  ca  e  o var oua ca a or  a   c   r                                           ' NORMAL BENEFITS AUTH~IZED SECTION IX                                                          ACTIVITY 47? STATUS (Cheek) 49? IF   0 PAYMENTS ARE CONTEMPLATED, THEY WILL BE EFFECTED ON REIMBURSABLE BAS 15 YE9        Q  NO               O  COMPLETE           Q  PARTIAL SECTION X                                              OFFSET OF INCOME 50. OFFSET OF INCOME AND OTHER EMOLUMENTS DERIVED FROM              ACTIVITIES  (If less than tole!, jus tl fy in aspara to wswo attaohed hereto.)                              ~  TO TAL~ PARTIAL       ?    NONE 444 -- 7 SECTION XI TERM 81?                  DURATION 82? EFFECTIVE DATE gS? RENEWABLE DAYL             MONTHS          YEAR8 13 March 1966 AYES           O NO b4? TERMINATION NOTICE (Number of days) 88? FORFEITURE OF RETURN TR AYEL FOR RESIGNATION PRIOR TO CONTRACT TERMINATIO DYES               ~NO SECTION XII                                           FUNCTION 88? PRIMARY FUNCTION SECTION XIII                                           DUTIES 87? GENERAL DESCRIPTION OF DUTIES TO BE PERFORMED To perform counter security inspections of a sensitive nature for the Office of Security. SECTION XIV                                          QUALIFICATIONS 88? E%PERIEN CE 1~+ years experience in Security field with CIA 89? EDUCATION GRADE 9CNDOL              NI ON SCHOOL GRADUATE    TRADE 9LNOOL GRADUATE Chock Highest SU91NE88 SCHOOL GRADUATE                     COMMERCIAL SCHOOL ORADUA TE Level Atleined COLL[OL  NO de fee          X  CO L.LE OL DE ORL[         P08T ORADUATL         MA     PND 80? LANGUAGE COMPETENCY LANGUAGE SPEAK WRITE READ 81? INDIVIDUAL'S FLUENT AVERAGE POO R FLUENT AVERAGE POO R FLUENT AVERA OE P00 COUNTRY OF ORIGIN Check Appropriate ~ ( Degree Competen cy g2? AREA KNOWLEDGE SECTION XV                                        EMPLOYMENT PRIOR TO CIA aa. GIVE INCLUSIVE DATES, POSITION TITLE OR TYPE WORK, SALARY AND REASON FOR LEAYINO NA SECTION XVI                                     ADDITIONAL INFORMATION 84? ADDITIONAL OR UNUSUAL REpUIREMENTS, JUSTIFICATIONS OR EXPLANATIONS (Use other aide if necessary) O VLR APPROVAL TYPE                 E OR REQUESTING OPERAT?  DATE          TV DATE                                                                                                    ACT APPROYIN6 INA                                                       w