[104-10194-10012.pdf — page 296]
# SECRET(when Filled In)## SECTION VGEOGRAPHIC AREA KNOWLEDGE AND FOREIGN TRAVEL| NAME OF REGION OR COUNTRY | TYPE OF SPECIALIZED ANOWLEDGE | MATES OF TRAVEL OR RESIDENCE | DATE & PLACE OF STUDY || ------------------------- | ----------------------------- | ---------------------------- | --------------------- ||                           |                               | MAY 30-2-13 FH-72-           |                       ||                           |                               |                              |                       ||                           |                               |                              |                       |KNOWLEDGE ACQUIRED BY- CHECK()| RESI- DENCE | TRAVEL | STUOV || ----------- | ------ | ----- ||             |        |       ||             |        |       ||             |        |       |## SECTION VITYPING AND STENOGRAPHIC SKILLS1. TYPING (PPV) 2.SHORTHAND (RPM) 3. INDICATE SHORTHAND SYSTEM USED- CHECK (X) APPROPRIATE ITEM[] GREGG[] SPEFOWRITING[] STENOTYPE[] OTHER SPECIFY:## SECTION VIISPECIAL QUALIFICATIONSPROVIDE INFORMATION ON HOBBIES, SPORTS. LICENSES PUBLISHED MATERIALS OR DEVICES, WHICH YOU MAY HAVE INVENTED.## SECTION VIIIMILITARY SERVICECURRENT DRAFT STATUS1. HAS YOUR SELECTIVE SERVICE CLASSIFICATION CHANGED?[] YES[] NO2. NEW CLASSIFICATION3. LOCAL SELECTIVE SERVICE BOARD NUMBER AND ADDRESS4. IF DEFERNED, GIVE REASONMILITARY RESERVE, NATIONAL GUARD STATUSCHECK RESERVE OR GUARD ORGANI- "ZATION 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)[] STAND BY (InActivey[] RETIRED[] DISCHARGED5. MILITARY MOBILIZATION ASSIGNMENT6. 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 IXPROFESSIONAL SOCIETIES AND OTHER ORGANIZATIONS| NAME AND CHAPTER | ADDRESS (Number, Street, City, State.Country) | DATE OF MEMBERSHIP || ---------------- | --------------------------------------------- | ------------------ ||                  |                                               | FROM TO            || 1.               |                                               |                    || 2.               |                                               |                    || 3.               |                                               |                    |## SECTION XREMARKS|| 9 May 1972            |                          || --------------------- | ------------------------ || SIGNATURE OF EMPLOYEE | ![signature of employee] |SECRET