[104-10193-10079.pdf — page 269]
23. REFERENCES--List three persons living in the United States or Territories of the United States who are NOT related to you and who have definite knowledge of your qualifications and fitness for the position for which you are applying. Do not repeat names of supervisors name under Item 16 (ITEM #20).FULL NAME:MR. EDWARD SAUNDERSMISS OLIVE REDDICKMISS RHEA FLUEBUSINESS OR HOME ADDRESS(Give complete address, including street and number)2430 E St., N.W., Washington, D.C.Telephone EX 6115, ext. 445Hood College, Frederick, Md.23rd and E Sts., N.W. Washington DC State Department/CRIBUSINESS OF OCCUPATIONGovernmentProfessorGovernment34. May inquiry be made of your present employer regarding your character, qualifications, etc.? YES NOIndicate "Yes" or "No" answer by placing X in proper column. Indicate "Yes" or "No" answer by placing X in proper column.28. Are you a citizen of the United States?29. Do you advocate or have you ever advocated, or are you now or have you ever been a member of any organization that advocates the overthrow of the Government of the United States by force or violence?...If your answer is "Yes," give complete details in Item 39.27. Within the past 12 months, have you habitually used, selling, or given away narcotics or stimulant drugs?28. Since your 18th birthday, have you ever been convicted of, fined or imprisoned; or placed on probation; or have you ever been ordered to deposit bail, for the violation of any law, police regulation or ordinance (including minor traffic violations for which a fine of $25 or less was imposed)?...If your answer is "Yes," list all such cases under Item 39 below. Give in each case (1) the nature of the offense or violation, (2) the name and location of the court, (4) the penalty imposed, if any or other disposition of the case. (5) appoved your fingerprints will be tutan...29. Have you ever been discharged or forced to resign for misconduct or unsatisfactory service from any position?...If your answer is "Yes," give in Item 39 the name and address of employer, date, and reason in each case.30. Do you receive an annuity from the U. S. or D. C. Government under any retirement act or any pension of other compensation for military or naval service?...If your answer is "Yes," give in Item 39 reason for retirement; that is age, optional, disability, or by reason of voluntary or involuntary separation after 5 years service, amount of retirement pay, and under what retirement act and rating if retired from military or naval service.31. Are you an official or employee of any State, Territory, county, or municipality?...If your answer is "Yes," give details in Item 39.32. Does the U. S. Government employ in a civil or military capacity anyone related to you by blood or marriage) with whom you live or have lived within the past 6 months?...If your answer is "Yes," show in Item 39 for EACH relative (1) full name, (2) present address, (3) relationship, (4) department or agency by whom employed, and (5) kind of appointment.33. Have you ever had a nervous breakdown?...If your answer is "Yes," give complete details in Item 39.34. Have you ever had tuberculosis?...If your answer is "Yes," give complete details in Item 39.36. (a) Were you in the United States Military or Naval Service during time at War?(b) Is the word "honorable" or the word "satisfactory" used in your discharge or separation papers to show the type of your discharge or separation?...(c) Was service performed on an active full time basis, with full military pay and allowances?...YESNODate of entry or entrance into serv- Date of separation or separations ice:Branch of service Serial No. (If none, give grade or rating at (Army, Navy, Mar. time of separation)C. G., etc.)IF YOUR ANSWERS TO THIS QUESTION (No. 36) INDICATE THAT YOU ARE ENTITLED TO VETERAN PREFERENCE, SUCH PREFERENCE WILL BE CREDITED IN THE EXAMINATION. IF APPOINTED, YOU WILL BE REQUIRED TO FURNISH TO THE APPOINTING OFFICER, PRIOR TO ENTRY ON DUTY, OFFICIAL EVIDENCE OF SEPARATION FROM YOUR LATEST PERIOD OF ACTIVE SERVICE IN THE ARMED FORCES OF THE UNITED STATES DURING TIME OF WAR. DO NOT SUBMIT PROOF OF DISCHARGE OR SEPARATION WITH THIS APPLICATION.Indicate "Yes" or No answer by placing X in proper column.YES NO37. (a) If you served in the U. S. Military or Naval Service during peacetime ONLY, did you participate in a campaign or expedition and receive a campaign badge or service ribbon?...(b) Are you a disabled veteran?...(c) Are you the unremarried widow of a veteran?...(d) Are you the war veteran who has service-connected disability?...IF YOUR ANSWER TO SUBSECTION 37(b), (c) OR (d) IS "YES," AND YOU WISH TO CLAIM CREDIT ATTACH TO THIS APPLICATION SERVICE COMMON FORM 14 TOGETHER WITH THE NECESSARY PROOF SPECIFIED THEREON.THIS SPACE FOR USE OF APPOINTING OFFICE ONLYThe information concerning the answers to Question 36 above has been verified by comparison with the discharge certificate on ........................................, 19.....AgencyTitle39. Space for detailed answers to other questions; indicate item numbers to which answers apply.ITEM No.ITEM No.If more space is required, use paper the same size as this page. Write on each sheet your name, address and examination title. Attach to this page.FALSE STATEMENT ON THIS APPLICATION IS PUNISHABLE BY LAW JU. S. CODE TITLE 18-SECT7R. 371.I certify that the statements made by me in this application are true, complete and correct to the best of my knowledge and belief, and are made in good faith.DateSignature of applicant(Sign your name in INK (one given name, middle and surname). If woman, prefix Miss or Mrs. and if married use your own given name -- Mary L. Doe.")