[104-10194-10023.pdf — page 6]
# RITESILet three persons living in the United States who areyour qualitate and stands for the position you are applying. Do not repeat names of supervisorsFULL NAME(Give complete current address, including street and number)BUSINESS OR OCCUPATION1. Maj.Gen. J. Donovan   2 Wall Street, New York 5. H. AttorneyJohn C. Farrar53 East 34th Street, New York 16 PublisherRaymond Rubicam444 Madison Avenue, New York 16 ExecutiveINDICATE "YES" OR "NO" ANSWER BY PLACING "X" IN PROPER COLUMN25 ARE YOU AWARE OF YOUR PRESENT EMPLOYER REGARDING YOUR CHARACTER OUALIFICATIONS. ETC.? Yep26 ARE YOU A CITIZEN OF OR DO YOU OWE ALLEGIANCE TO THE UNITED STATES? Yau27 ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF THE COMMUNIST PARTY U4 OR ANY CLINIC ORGANIZATION? No28 ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF A FASCIST ORGAN No29 ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF ANY ORGANIZATION, ASSOCIATION, MOVEMENT, GROUP OR COMBINATION OF PERSONS WHICH ADVOCATES OR APPROVES OR CONSTITUTES A CONTINUOUS VIOLATION OF LAW OR ADVOCATES THE OVERTHROW OF OUR CONSTITUTIONAL FORM OF GOVERNMENT OF THE UNITED STATES OR ADVOCATES A POLICY OF ADVOCATING OR APPROVING THE COMMISSION OF ACTS OF FORCE OR VIOLENCE TO DENY ANY OTHER PERSONS THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES, OR TO ALTER THE FORM OF GOVERNMENT OF THE UNITED STATES BY UNCONSTITUTIONAL MEANS NoIf your answer to questions 27, 28, or 29 above is "yes" state in Item 30 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 activities therein30. SINCE YOUR 16TH BIRTHDAY, HAVE YOU EVER BEEN ARRESTED, INDICTED OR SUMMONSED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING OR CONVICTED OF ANY OFFENSE OR IMPRISONED OR PLACED ON PROBATION OR HAVE YOU EVER BEEN COMPELLED TO FORFEIT BAIL OR COLLATERAL FROM THE VIOLATION OF ANY LAW, POLICE REGULATION OR ORDINANCE (EXCLUDING MINOR TRAFFIC VIOLATIONS FOR WHICH A FINE OR FORFEITURE OF LESS WAS IMPOSED)? NoIf your answer is "Yes list all such cases under Item 30 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 our discretion will be takenaddress of employer, date, and reason in each case No32 HAVE YOU EVER BEEN BARRED BY THE U. S. CIVIL SERVICE COMMISSION FROM TAKING EXAMINATIONS OR ACCEPTING CIVIL SERVICE APPOINTMENT? NoIf your answer is "Yes" give dates of and reasons for such debarment to Item 3933. HAVE YOU ANY PHYSICAL HANDICAP, DISEASE OR OTHER DISABILITY WHICH SHOULD BE CONSIDERED IN ASSIGNING YOU TO WORK? NoIf your answer is "Yes", give complete details in Item 30 so that consideration can be given to your physical fitness for the job34 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? NoIf your answer is "Yes" give complete details in Item 39SPACE FOR ANSWERS TO OTHER QUESTIONS (Indicate item numbers to which answers apply)ITEM NOINDICATE "YES" OR "NO" ANSWER BY PLACING "X" IN PROPER COLUMN35 ARE YOU AN OFFICIAL OR EMPLOYEE OF ANY STATE, TERRITORY, COUNTY, OR MUNICIPALITY? If your answer is "Yes," give details in Item 3936 HAS THE UNITED STATES GOVERNMENT ANY OF YOUR RELATIVES IN A CIVILIAN CAPACITY AT OR NEAR THE DUTY STATION FOR WHICH YOU HAVE APPLIED WITHIN THE PAST 24 MONTHS? If your answer is "Yes," show in Item 37 for EACH such relative (1) full name, (2) present address (3) relationship, (4) Department or Agency by which employed and (5) kind of appointmentYESNOSPECIAL INSTRUCTIONS FOR CLAIMING VETERAN PREFERENCEA. If you are claiming preference as a PEACETIME VETERAN who has been awarded a campaign badge or service medal, or as a DISABLED VETERAN or as the WIFE OF A DISABLED VETERAN, or as the WIDOW OF A WAR OR CAMPAIGN VETERAN, attach Veterans Preference Claim, CSC Form 14, together with proof specified therein.If. If you are a WAR-TIME VETERAN and are claiming disability preference. you should NOT submit your discharge with this application Preference will be tentatively credited to you and if appointment should be required to submit to the appointing officer prior to entry on duty, official evidence of separate 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? X(B) IS THE WORD "HONORABLE" OR THE WORD "SATISFACTORY" USED ON YOUR DISCHARGE OR SEPARATION PAPERS TO SHOW THE TYPE OF YOUR DISCHARGE OR SEPARATION? X(C) WAS SERVICE PERFORMED ON AN ACTIVE FULL-TIME BASIS WITH FULL MILITARY PAY AND ALLOWANCES? XJuly 1940 March 1942 APARATIONSSept. 1943 March 1946 See grade o rating af time of separationFIRST SERVICE (Army, Navy, Marine Corps, Coast Guard, eta) 0-587241/97532Navy- ArmyTHE STATES NO X(D) ARE YOU A DISABLED VETERAN? If so, and you have not listed your disability in answer to Item 33, explain in Item 39 below X(E) ARE YOU A VETERAN'S WIDOW WHO HAS NOT REMARRIED? X(F) ARE YOU THE WIFE OF A VETERAN WHO HAS A SERVICE-CONNECTED DISABILITY WHICH DISQUALIFIES HIM FOR CIVIL SERVICE APPOINTMENT? XTHIS SPACE FOR USE OF APPOINTING OFFICER ONLYThe information contained in the answers to Questions 37 above has been veri- fied by comparison with the discharge certificate on 6-1 10.49Agency:(Indicate item numbers to which answers apply)Distr.If 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 inside of this application.Before 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 CAPPLICANT Ind(Sign your name in INK (one given name in full, initial or initials, and surname. If female, use our own given name as Mrs. Mary L.10-43388-1PERSONNEL POSTING OFFICE