[104-10193-10077.pdf — page 136]
# SECRET(When Filled In)## SECTION V GEOGRAPHIC AREA KNOWLEDGE AND FOREIGN TRAVEL| NAME OF REGION OR COUNTRY | TYPE OF SPECIALIZED KNOWLEDGE | DATES OF TRAVEL OR RESIDENCE | DATE & PLACE OF STUDY | KNOWLEDGE ACQUIRED BY CHECK (N) RESIDENCE | TRAVEL | STUDY | WORK ASSIGNMENT || ------------------------- | ----------------------------- | ---------------------------- | --------------------- | ----------------------------------------- | ------ | ----- | --------------- ||                           |                               |                              |                       |                                           |        |       |                 ||                           |                               |                              |                       |                                           |        |       |                 ||                           |                               |                              |                       |                                           |        |       |                 |## SECTION VI TYPING AND STENOGRAPHIC SKILLS1. TYPING (PPM) 2. SHORTHAND(WPM) 3: INDICATE SHORTHAND SYSTEM USED- CHECK (X) APPROPRIATE ITEM☐ GREGG☐ SPEEDWRITING☐ STENOTYPE☐ OTHER, SPECIFY:## SECTION VII SPECIAL QUALIFICATIONSPROVIDE INFORMATION ON HOBBIES, SPORTS, LICENSES, PUBLISHED MATERIALS, OR DEVICES WHICH YOU MAY HAVE INVENTED.## SECTION VIII MILITARY SERVICE CURRENT DRAFT STATUS1. HAS YOUR SELECTIVE SERVICE CLASSIFICATION CHANGED? 2. NEW CLASSIFICATION☐ YES☐ NO3. LOCAL SELECTIVE SERVICE BOARD NUMBER AND ADDRESS 4. IF DEFERRED, GIVE REASONMILITARY RESERVE, NATIONAL GUARD STATUSCHECK RESERVE OR GUARD ORGANIZATION TO WHICH YOU BELONG☐ ARMY☐ MARINE CORPS☐ COAST GUARD☐ NATIONAL GUARD☐ NAVY☐ AIR FORCE☐ AIR NATIONAL GUARD1. CURRENT RANK, GRADE OR RATE 2. DATE OF APPOINTMENT IN CURRENT RANK 3. EXPIRATION DATE OF CURRENT OBLIGATION4. CHECK CURRENT RESERVE CATEGORY☐ READY RESERVE☐ STANDBY(active)☐ STANDBY(inactive)☐ RETIRED☐ DISCHARGED5. MILITARY MOBILIZATION ASSIGNMENT 6. RESERVE UNIT TO WHICH ASSIGNED OR ATTACHEDMILITARY SCHOOLS COMPLETED (Extended Active, Reserve Duty, or as Civilian)| NAME AND ADDRESS OF SCHOOL | STUDY OR SPECIALIZATION | DATE COMPLETED | RESIDENT | AGENCY-SPONSORED || -------------------------- | ----------------------- | -------------- | -------- | ---------------- ||                            |                         |                |          |                  ||                            |                         |                |          |                  |## SECTION IX PROFESSIONAL SOCIETIES AND OTHER ORGANIZATIONS| NAME AND CHAPTER | ADDRESS (Number, Street, City, State, Country) | DATE OF MEMBERSHIP FROM | TO  || ---------------- | ---------------------------------------------- | ----------------------- | --- ||                  |                                                |                         |     ||                  |                                                |                         |     ||                  |                                                |                         |     |## SECTION X REMARKSDATE SIGNATURE OF EMPLOYEE8 Jan 1971SECRET