[104-10193-10076.pdf — page 95]
14-00000| FULL NAME      | BUSINESS OR HOME ADDRESS           | BUSINESS OR OCCUPATION || -------------- | ---------------------------------- | ---------------------- || B. P. Small    | Sycamore Bldg-Terre Haute, Indiana | Atty                   || E. L. Zeigler  | Cochran Bldg., Maysville, Ky.      | Atty                   || A. N. Thurston | C.I.G.- Washington, D. C.          |                        |24. May inquiry be made of your present employer regarding your character qualifications, etc.?  [ ] Yes  [X] NoIndicate "Yes" or "No" answer by placing X in proper column.| YES                                                                                                                                                                                                         | NO  || ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --- || 25. Are you a citizen of the United States?                                                                                                                                                                 | [X] || 26. 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? | [X] |If your answer is "Yes," give complete details in Item 38.27. Within the past 12 months, have you habitually used intoxicants to excess? | [X] |28. Since your 16th birthday, have you ever been convicted of, forfeited collateral, or been placed on probation, or have you ever been required to register because of the violation of any law, peace ordinance or ordinance relating to minor traffic violations for which a fine of $25 or less was imposed? | [X] |If your answer is "Yes," list all such cases under Item 38 below. Give in each case (1) the date, (2) the nature of the offense or violation, (3) the name and location of the court, (4) the penalty imposed, if any, or other disposition of the case. If appointed your fingerprints will be taken.29. Have you ever been discharged or forced to resign for misconduct or unsatisfactory service from any position? | [X] |If your answer is "Yes" give in Item 38 the name and address of employer, date, and reason in each case.30. Do you receive an annuity from the U. S. D. C. Government under any retirement act or any pension or other compensation for military or naval service? | [X] |If your answer is "Yes," give in Item 38 reason for retirement, that is, age, optional, disability or voluntary or involuntary separation after 5 years' service, amount of government 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? | [X] |If your answer is "Yes" give details in Item 38.32. Does the U. S. Government employ in a civilian capacity any relative of yours (by blood or marriage) with whom you live or have lived within the past 6 months? | [X] |If your answer is "Yes" show in Item 38 for EACH such relative (1) full name (2) present address, (3) relationship, (4) department or agency by whom employed, and (5) kind of appointment.Indicate "Yes" or "No" answer by placing X in proper column.| YES                                                        | NO  || ---------------------------------------------------------- | --- || 35. Have you any physical defect or disability whatsoever? | [X] |If your answer is "Yes" give complete details in Item 38.36. (a) Were you ever in the United States Military or Naval Service during time of War? | [X] |(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?Date of entry or entries into service:Date of separation or service below:Branch of service(Army, Navy, M. C., C. G., etc.)Serial No. (if none, give grade or rating at time of separation.)IF YOUR ANSWERS TO THIS QUESTION (No. 36) INDICATE THAT YOU ARE ENTITLED TO VETERAN PREFERENCE IT 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 OF SEPARATION WITH THIS APPLICATION.Indicate Yes or No answer by placing X in proper column.| YES                                                                                                                                                                                 | NO  || ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --- || 37. (a) If you served in the U. S. Military or Naval Service during peace time ONLY, did you participate in a campaign or expedition and receive a campaign badge or service medal? | [X] || (b) Are you a disabled veteran?                                                                                                                                                     | [X] || (c) Are you the unmarried widow of a veteran?                                                                                                                                       | [X] || (d) Are you the wife of a veteran who has service-connected disability?                                                                                                             | [X] |IF YOUR ANSWER TO QUESTION 37 (b), (c) or (d) IS "YES" AND YOU WISH TO CLAIM VETERAN PREFERENCE ATTACH TO THIS APPLICATION VETERAN PREFERENCE CLAIMS SERVICE COMMAND FORM 14) TOGETHER WITH THE NECESSARY PROOF SPECIFIED THEREIN.THIS SPACE FOR USE OF APPOINTING OFFICE ONLYThe information contained in the answers to Question 35 above has been verified by comparison with the discharge certificate on.33. Have you ever had a nervous break down? | [X] |    If your answer is "Yes" give complete details in Item 38.34. Have you ever had tuberculosis? | [X] |    If your answer is "Yes" give complete details in Item 38.38. Space for detailed answers to other questions (Indicate item numbers)ITEM NOITEM NOIf more space is required, use paper the same size as this page. Write on each sheet your name, address, date of birth, and examination title. Attach to this application.FALSE STATEMENT ON THIS APPLICATION IS PUNISHABLE BY LAW (U. S. CODE TITLE 18, SECTION 1001)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, initial, and last name)If female, prefix Miss or Mrs.)490 16-17433-4