Laserfiche WebLink
DEFENSE CIVIL PREPAREDNESS AGENCY <br />DEPARTMENT OF DEFEN::E. <br />NOTIFICATION OF APPOINTMENT - CIVIL DEFENSE DIRECTOR <br />INSTRUCTIONS <br />Complete and forward to DCPA Region:. ' Director for further transmittal to DCPA, Plans and Operations Directorate, State and <br />Local Readiness Div., Washington, D.C. 20301, for each new appointment of a State or countylctty Civil Defense Director. <br />PRIVACY ACT STATEMENT I. AUTHORITY. 50 U.S.C. App. 2281 2. PRINCIPAL. PURPOSES: To update DCPA list of <br />civil def ense directors and obtain biographical data on new appointees. 3. ROU7'INL USE 70 deal with State and local civil <br />defense directors, including correspondence, selecting committees, and the like. 4. MANDATORY OR VOLUNTARY DISCLO."'.'ll ('.. <br />Disclosure is voluntary. There is no requirement to, or authority to, impose a penalty for failure to respond. 5. EFFECT ON <br />INDIVIDUAL FOR NOT PROVIDING INFORMATION. If data is not submitted, DCPA dealing with individual directors will <br />be less knowledgeable. <br />NAME <br />DATE: I STATE. AND LOCALIT4 <br />OF APPOINTMENT I <br />TITLE OF CD DIRECTOR /COORDINATOR <br />POPULATION COVERED TABLE ENTRY NUMBER <br />(1970 CENSUS) (where appropnatel <br />E FULL TIME HALF TIME E OTHER PART TIME <br />P & A PARTICIPANT ❑ r� <br />YES LJ NO <br />MAILING ADDRESS OF CIVIL DEFENSE OFFICE (Include <br />Zlp c000) <br />OF <br />DEFENSE' <br />CIVIL DEFENSE <br />NAME, TITLE AND ADDRESS OF CHIEF EXECUTIVE <br />PERSONAL <br />(FOR STATE DIRECTORS AND DIRECTORS <br />PROVIDE BRIEF BIOGRAPHICAL BACKGROUND <br />EXPERIENCE / RANK, PRIOR CIVIL <br />OR EXPERIENCE PERTINENT TO THE <br />DATA <br />POLITICAL SUBDIVISIONS OVER 100,000) <br />ON APPOINTEES. SUCH AS MILITARY <br />EXPERIENCE OR OTHER MAJOR POSITION <br />DIRECTOR POSITION. <br />HOME ADDRESS (Include ZIP code) <br />.I <br />i DATE OF BIRTH <br />PLACE OF BIRTH <br />BUSINFS S PHONE <br />1 <br />HOME PHONE <br />BIOGRAPHICAL DATA <br />REMARKS <br />(DATE 'TITLE <br />DCPA o n 89n. Soptemne: 7!. <br />SIGN7111 0I. <br />Replace, DCPA‘ F Orr,, peg, MA, 7- _ wrni I4 MHA N('1 Fl USE L <br />4i <br />