HR - REQUEST FOR PCS OVERSEAS EVALUATION -(SANITIZED)

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0005382562
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 1
• Document Creation Date: June 24, 2015
• Document Release Date: January 31, 2011
• Case Number: F-2009-00333
• Publication Date: February 4, 1980

REQUEST FOR PICS OVERSEAS
OMS DATE
1. REQUEST DATE (DA MO. YRI
2 APPLICANT HASAPPLI ANT PREVIOUSLY BEEN
EVALUATION
SEEN BYOMS EIYES ENO
DEPENDENTISI EMPLOYEE
3. NAME p.avq h)eR Middle)
6. DOB (DA MO. YRI
7. SEX
Illy Anne X.
6A l ?
k
8. GRADE
9. AFFILIATION +CyD
A
l
10. DIRECTOR`AATPE/OFICE/DIVISION
DD
11. EMP. EXT. 12 POSITION TITLE
y @{.
A
d
l
]-`E Fi
sst
t'4
&
COMPLETE 13-19 FOR EACH DEPENDENT TO ACCOMPANY OR RETURN WITH EMPLOYEE ONLY IF 2/S CHECKED 'DEPENDENT(S)"
19. DEPENDENT
PREVIOUSLY SEEN
13. DEPENDENT NAME IL FM) 1
4.
SOC SEC NO.
'BOB (DMY) 1
]. SEX 1
8. RELATIONSHIP
BY OMS (yes aol
n
ci
M~wl
REQUESTED ACTION (mare than ant aelion h' aaaepmble)
20.
APPLICANT:
PREEMPLOYMENT
EOD
ETO/ETA (DA M(F YEN
NO.OF DEPENDENTS TO
O/S PC$
y ul90
ffYE
ACCOMPAI;~Y OR RETURN
O/S TOY, SPECIFY
T??II
rnv
POSITION
ASSIGNMENTS:
E Asst
.AT +;A` Asst
O/S RETURNEE
FITNESS FOR DUTY
OTHER (specify)
O/S TDY STANDBY
RETURN TO DUTY
O/S PLANNING
SPECIAL TRAINING
SEPARATION'
RETIREMENT
MDR/CIARDS
MDR/CSC
ROUTINE REGULAR NI
EXECUTIVE PHYSICAL
01. COMMENTS
ESTING
22. REQ
T
ORATE/OFFICEIDIV
IRE
C
23.A
MBLDG 24. EXTENSION 21, SIGNATURE OF REQUESTING OFFICER
D
~
g
E
U
3 DI)/ El. IV,
26. OFFICE OF SECURITY DISPOSITION
27. OVERSEAS CANDIDATE REVIEW PANEL DISPOSITION
QUALIFIED FOR PJ1 OSED LSSJGNMENT OVERSEAS
a to
~4
jPP
Review
E
CLASSIFY AS APPROPRIATE
junnn 2598 Eo llI1eOus L
8-Op
APPROVED FOR
(when app icable)
RELEASED DATE:
04-Aug-2010