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• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP80-01370R000200100014-4
• Release Decision: RIFPUB
• Original Classification: U
• Document Page Count: 2
• Document Creation Date: December 9, 2016
• Document Release Date: June 13, 2001
• Sequence Number: 14
• Content Type: FORM

Approved For Release 2001/08/14: CIA-RDP80-0137OR000200100014-4
TAB
Approved For Release 2001/08/14: CIA-RDP80-0137OR000200100014-4
 Approved For Release 2001/08/14: CIA-RDP80-0137OR000200100014-4
Serial `:o.
Name of Tployee (Last-Firs,-xiddle)
Office
-
Roos No.
_
Building
Office Phone Category Date
1
f
Home Address
(D:umber, Street, City, 'one, State) - Overseas Address, If Applicable
Home Telephone Number
Mane of Emergency Addressee
W
W
Relationship
Addressee's Home Tel. No
6
; o
mer.,-envy Addressee's Hone Address (`Dumber, Street, City, ?one
State)
,
Code Designee Witting of
Agency Employment
? R PDY1ING CHANGES: Using Form 6112 maintained in the Office File, fill in ONLY items affected in items 1 through 13 and
note reasons for changes in "Remark
"
F
h
s
.
or c
ange to OVERSEAS ADDRESS, complete items 1, 2 and 4 (For W-2 Purposes).
? FOR TRANSFERS WITHIN HEADCUAR-'EP.S: Transferee will hand-carry Office File copy of Form 642 to
ainin
g
g component for
completion, certification and forwarding to Machine Records Division
.
0 FOR NEW EM?LOYEFS: Fill in items 1 through 13 and write "NEW EMPLOYEE" under "Remarks", using blank Form 642.
? Select from "LI:~TATION CATEGORY" th
t
e ca
egory indicating extent information may be used. Write appropriate category
number in box provided.
0 Peview items for accuracy and currency; then certify below. Send immediately to Machine Records Division. For security
and administrative re
o
i
i
as
ns,
t
s imperative that all changes, additions and/or deletions be reported promptly.
SPACE BELOW FOR REPORTING CHANGES AND ADDITIONS ONLY
L Serial No.
2. Name of Employee (Last-First-Middle)
3. Office/Division- Room No.- Building -Office Telephone
a
n
Home Addres
4
(N
b
S
.
s
um
er,
treet, City, lone, State) - Overseas Address, If Applicable
SNumber
U w
6.Name of Emergency Addressee
7.Relationship
8. Addressee's Home Telephone No.
U 9. Emergency Addressee's Hone Address (Number, Street, City, lone, State) 1C. Is Designee Witting
Yes
? of Your Agency
to ent ? No
11. Remarks
Signature of Approving Admin. Officer
13. Limitation
1 - List in Agency phone directory. Record in telephone and mail rooms for all inquiries
Category
2
.
- Do NOT list in Agency phone directory. Record in telephone and mail rooms for all
inquiries.
INSERr
NU1~ER
3 - Do NOT list in Agency phone directory. Record in telephone and mail rooms for antra-Agency
HERE
i
F
nquiries only.
4 - Record in mast
l
er
ocator file for AUTHCED a iGSN_CY US? ONLY.
CRAFT Cr REVISED FORM 642, PERSONNEL EMERGENCY AND LOCATOR RECORD (forn:erly "Personnel Information Card")
DIMENSIONS: 8 x $ inches overall, including non-detachable pinfeed punch margin.
RO
o-~
N k
0-
Approved For Release 2001/08/14: CIA-RDP80-0137OR000200100014-4