[104-10194-10023.pdf — page 31]
24. REFERENCE: List three persons living in the United States or the United States who are related, or have definite knowledge of your qualifications and fitness for the position for which you are applying. Do not repeat names of supervisors listed under Item 16 (EXPERIENCE).| FULL NAME                | (Give complete current address, including street and number) | BUSINESS OR OCCUPATION || ------------------------ | ------------------------------------------------------------ | ---------------------- || Maj. Gen. Wm. J. Donovan | 2 Wall Street, New York 5, N.Y.                              | Attorney               || John C. Farrar           | 53 East 34th Street, New York 16                             | Publisher              || Raymond Rubicam          | 444 Madison Avenue, New York 16                              | Executive              |INDICATE "YES" OR "NO" ANSWER BY PLACING "X" IN PROPER COLUMN25. | MAY INQUIRY BE MADE OF YOUR PRESENT EMPLOYER REGARDING YOUR CHARACTER QUALIFICATIONS, ETC.? | YES | NO  |    | ------------------------------------------------------------------------------------------- | --- | --- |    | Yes                                                                                         |     |     |26. | ARE YOU A CITIZEN OF OR DO YOU OWE ALLEGIANCE TO THE UNITED STATES? | YES | NO  |    | ------------------------------------------------------------------- | --- | --- |    | Yes                                                                 |     |     |27. | ARE YOU NOW, OR HAVE YOU EVER BEEN, A MEMBER OF THE COMMUNIST PARTY, U.S.A., OR ANY COMMUNIST ORGANIZATION? | YES | NO  |    | ----------------------------------------------------------------------------------------------------------- | --- | --- |    |                                                                                                             | No  |     |28. | ARE YOU NOW, OR HAVE YOU EVER BEEN, A MEMBER OF A FASCIST ORGANIZATION? | YES | NO  |    | ----------------------------------------------------------------------- | --- | --- |    |                                                                         | No  |     |29. | ARE YOU NOW, OR HAVE YOU EVER BEEN, A MEMBER OF ANY ORGANIZATION, ASSOCIATION, MOVEMENT, GROUP, OR COMBINATION OF PERSONS WHICH ADVOCATES, OR TEACHES, THE OVERTHROW OR ALTERATION OF THE CONSTITUTIONAL FORM OF GOVERNMENT OF THE UNITED STATES BY FORCE OR VIOLENCE OR OTHER UNCONSTITUTIONAL MEANS? | YES | NO  |    | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | --- | --- |    |                                                                                                                                                                                                                                                                                                        | No  |     |If your answer to question 27, 28, or 29 above is "yes," state in Item 39 the names of all such organizations, associations, movements, groups, or combination of persons and dates of membership. Give complete details of your activities therein and make any explanation you desire regarding your membership or activities therein.31. | SINCE YOUR 16TH BIRTHDAY, HAVE YOU EVER BEEN ARRESTED, INDICTED, OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING, CONVICTED, FINED, OR IMPRISONED OR PLACED ON PAROLE; OR WITHIN THE LAST TWELVE MONTHS BEEN REQUIRED TO POST BAIL OR COLLATERAL FOR THE VIOLATION OF ANY LAW, POLICE REGULATION OR ORDINANCE, INCLUDING TRAFFIC REGULATIONS FOR WHICH A FINE OR FORFEITURE OF $25 OR LESS WAS IMPOSED? | YES | NO  |    | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --- | --- |    |                                                                                                                                                                                                                                                                                                                                                                                                                        | No  |     |If your answer is "Yes," list all such cases under Item 39. 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.32. | HAVE YOU EVER BEEN DISCHARGED OR FORCED TO RESIGN, FOR MISCONDUCT OR UNSATISFACTORY SERVICE, FROM ANY POSITION? | YES | NO  |    | --------------------------------------------------------------------------------------------------------------- | --- | --- |    |                                                                                                                 | No  |     |If your answer is "Yes," give in Item 39 the name and address of employer, date, and reason in each case.33. | HAVE YOU EVER BEEN BARRED BY THE U. S. CIVIL SERVICE COMMISSION FROM TAKING EXAMINATIONS OR ACCEPTING CIVIL SERVICE APPOINTMENT? | YES | NO  |    | -------------------------------------------------------------------------------------------------------------------------------- | --- | --- |    |                                                                                                                                  | No  |     |If your answer is "Yes," give dates of and reasons for such debarment in Item 39.34. | HAVE YOU ANY PHYSICAL HANDICAP, DISEASE, OR OTHER DISABILITY WHICH SHOULD BE CONSIDERED IN ASSIGNING YOU TO WORK? | YES | NO  |    | ----------------------------------------------------------------------------------------------------------------- | --- | --- |    |                                                                                                                   | No  |     |If your answer is "Yes," give complete details in Item 39 so that consideration can be given to your physical fitness for job.36. | DO YOU RECEIVE AN ANNUITY FROM THE UNITED STATES OR DISTRICT OF COLUMBIA GOVERNMENT UNDER ANY RETIREMENT ACT OR ANY PENSION OR OTHER COMPENSATION FOR MILITARY OR NAVAL SERVICE? | YES | NO  |    | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --- | --- |    |                                                                                                                                                                                  | No  |     |If your answer is "Yes," give complete details in Item 39.INDICATE "YES" OR "NO" ANSWER BY PLACING "X" IN PROPER COLUMN35. | ARE YOU AN OFFICIAL OR EMPLOYEE OF ANY STATE, TERRITORY, COUNTY, OR MUNICIPALITY? | YES | NO  |    | --------------------------------------------------------------------------------- | --- | --- |    | If your answer is "Yes," give details in Item 39.                                 |     |     |36. | HAS THE UNITED STATES GOVERNMENT EMPLOYED IN A CIVILIAN CAPACITY ANY RELATIVE OF YOURS BY BLOOD OR MARRIAGE WITH WHOM YOU LIVE (OR HAD LIVED WITHIN THE PAST 24 MONTHS?                      | YES | NO  |    | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --- | --- |    | If your answer is "Yes," show in Item 39 IN EACH such relative (1) full name, (2) present address, (3) relationship; (4) Department or Agency by which employed, and (5) kind of appointment |     |     |SPECIAL INSTRUCTIONS FOR CLAIMING VETERAN PREFERENCEA. If you are claiming preference as a PEACETIME VETERAN who has been awarded a campaign badge or service ribbon; or as a DISABLED VET- ERAN; or as the WIFE OF A DISABLED VETERAN, or as the WIDOW OF A WAR OR CAMPAIGN VETERAN, attach Veteran Preference Claim, CSC Form 14, together with proof papers thereto.B. If you are a WAR-TIME VETERAN claiming disability preference, you should NOT submit your discharge with this application. Preference will be tentatively granted to you and, if successful, you will be required to submit supporting evidence to entry in duty status and evidence of separate- tion from active service in the armed forces of the United States in time of war.37. | (A) WERE YOU EVER IN THE UNITED STATES MILITARY OR NAVAL SERVICE DURING TIME OF WAR? | YES | NO  |    | ------------------------------------------------------------------------------------ | --- | --- |    | 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? | YES | NO  || ---------------------------------------------------------------------------------------------------------------------------------------------------- | --- | --- || X                                                                                                                                                    |     |     || (C) WAS SERVICE PERFORMED ON AN ACTIVE FULL-TIME BASIS WITH FULL MILITARY PAY AND ALLOWANCES? | YES | NO  || --------------------------------------------------------------------------------------------- | --- | --- || X                                                                                             |     |     || D. PERIOD(S) OF ACTIVE DUTY (Give inclusive dates of each period of service) |                                                                         || ---------------------------------------------------------------------------- | ----------------------------------------------------------------------- || July 1940 to March 1942                                                      |                                                                         || Sept. 1943 to March 1946                                                     |                                                                         || BRANCH OF SERVICE (Army, Navy, Marine Corps, Coast Guard, etc.)              | SERIAL number (if any, also give grade or rating at time of separation) || Navy-Army                                                                    | 0-587241/97532                                                          |38. | IF YOU SERVED IN THE UNITED STATES MILITARY OR NAVAL SERVICE DURING PEACETIME ONLY, DID YOU PARTICIPATE IN A CAMPAIGN OR EXPEDITION AND RECEIVE A CAMPAIGN BADGE OR SERVICE RIBBON? | YES | NO  |    | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --- | --- |    | X                                                                                                                                                                                   |     |     || (A) ARE YOU A DISABLED VETERAN? | YES | NO  || ------------------------------- | --- | --- || X                               |     |     |If so, and you have not listed your disability in answer to Item 33, explain in Item 39 below. |  || (B) ARE YOU A VETERAN'S WIDOW WHO HAS NOT REMARRIED? | YES | NO  || ---------------------------------------------------- | --- | --- || X                                                    |     |     || (C) ARE YOU THE WIFE OF A VETERAN WHO HAS A SERVICE CONNECTED DISABILITY? | YES | NO  || ------------------------------------------------------------------------- | --- | --- || X                                                                         |     |     |THIS SPACE FOR USE OF APPOINTING OFFICER ONLYThe information contained in the answers to Question 37 above has been verified by comparison with the discharge certificate on 6-1 19. 49Agency: | Title:---SPACE FOR DETAILED ANSWERS TO OTHER QUESTIONS (Indicate item numbers to which answers apply)It 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 insideBefore signing this application check back over it to make sure that you have answered ALL questions correctly. 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.False statement on this application is punishable by Law (U. S. Code, Title 18, Section 80).[Signature of Applicant](Type your name in INK as given in your record. If female, cross out given name as "Mrs. Mary L. Doe")