[104-10194-10023.pdf — page 48]
# REDEFINES List third persons living in the United States or Territories of the United States who are NOT related to you and who have definite knowledge of your qualifications and fitness for the position for which you are applying. Enclose present names of supervisors listed under Item 16 (EXPERIENCE).| FULL NAME            | (Give complete current address, including street and number) | BUSINESS OR OCCUPATION || -------------------- | ------------------------------------------------------------ | ---------------------- || Westmore Wilcox, Jr. | 69 William St., New York City                                | Investments            || Robert G. North      | 2017 Iredonia Drive, Hollywood, Cal. Textiles                |                        || Maj. J. M. Sinclauh  | "L" Bldg., Washington, D.C.                                  | U.S. Army              || INDICATE "YES" OR "NO" ANSWER BY PLACING "X" IN PROPER COLUMN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       | YES | NO  | INDICATE "YES" OR "NO" ANSWER BY PLACING "X" IN PROPER COLUMN                                                                                                                                                                                                                                                                                                                                 | YES | NO  || ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --- | --- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --- | --- || 25. MAY INQUIRY BE MADE OF YOUR PRESENT EMPLOYER REGARDING YOUR CHARACTER QUALIFICATIONS, ETC.?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     | X   |     | 35. ARE YOU AN OFFICIAL OR EMPLOYEE OF ANY STATE, TERRITORY, COUNTY, OR MUNICIPALITY? If your answer is "Yes," give details in Item 37.                                                                                                                                                                                                                                                       |     | X   || 26. ARE YOU A CITIZEN OF THE UNITED STATES?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         | X   |     | 36. DOES THE UNITED STATES GOVERNMENT EMPLOY IN A CIVILIAN CAPACITY ANY RELATIVE OF YOURS BY BLOOD OR MARRIAGE WITH WHOM YOU LIVE OR MAY LIVE WITHIN THE PAST 12 MONTHS? If your answer is "Yes" show in Item 39 the EACH such relative (1) full name; (2) present address; (3) relationship; (4) Department or Agency by which employed, and (5) kind of appointment.                        |     | X   || 27. ARE YOU NOW, OR HAVE YOU EVER BEEN A MEMBER OF THE COMMUNIST PARTY U.S.A. OR ANY COMMUNIST ORGANIZATION?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |     | X   | **SPECIAL INSTRUCTIONS FOR CLAIMING VETERAN PREFERENCE**                                                                                                                                                                                                                                                                                                                                      |     |     || 28. ARE YOU NOW, OR HAVE YOU EVER BEEN A MEMBER OF A FASCIST ORGAN?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |     | X   | A. If you are claiming preference as a PEACETIME VETERAN who has been awarded a campaign badge or service ribbon, or as a DISABLED VETERAN, or as the WIFE OF A DISABLED VETERAN, or the WIDOW OF A WAR OR CAMPAIGN VETERAN, attach Veteran Preference Claim, CSC Form 14, together with your proof thereof therein.                                                                          |     |     || 29. ARE YOU NOW, OR HAVE YOU EVER BEEN A MEMBER OF ANY ORGANIZATION, ASSOCIATION, MOVEMENT, GROUP, OR COMBINATION OF PERSONS WHICH ADVOCATES THE OVERTHROW OF OUR CONSTITUTIONAL FORM OF GOVERNMENT OF THE UNITED STATES BY FORCE OR VIOLENCE OR OTHER UNCONSTITUTIONAL MEANS? (Include in your answer membership in any organization, association, movement, group, or combination of persons which has among its purposes or objectives, or which is affiliated with one or more organizations, associations, movements, groups, or combinations of persons which has among its purposes or objectives, the overthrow by force or violence or other unconstitutional means of the Government of the United States or which seeks to alter the form of Government of the United States by unconstitutional means). |     | X   | B. If you are WAR TIME VETERAN not claiming disability preference, you should NOT submit your discharge with this application. Preference will be tentatively credited to you and if appointed, you will be required to submit to the appointing officer prior to entry on duty, official evidence of separation from active service in the armed forces of the United States in time of war. |     |     |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 combinations 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.30. SINCE YOUR 16TH BIRTHDAY, HAVE YOU EVER BEEN ARRESTED, INDICTED, OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING OR CONVICTED, FINED, OR IMPRISONED, OR PLACED ON PROBATION OR HAVE YOU EVER BEEN ORDERED TO DEPOSIT BAIL OR COLLATERAL FOR THE VIOLATION OF ANY LAW, POLICE REGULATION OR ORDINANCE (EXCLUDING MINOR TRAFFIC VIOLATIONS FOR WHICH A FINE OR FORFEITURE OF $25.00 WAS IMPOSED)? If your answer is "Yes," list all such cases under Item 39 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. | X |  | 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 IN 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? | X |(D) DATE OF ENTRY OR ENTRANCE INTO SERVICE | DATE OF SEPARATION OR SEPARATION:31. HAVE YOU EVER BEEN DISCHARGED OR FORCED TO RESIGN FOR MISCONDUCT OR UNSATISFACTORY SERVICE FROM ANY POSITION? If your answer is "Yes," give in Item 39 the name and address of employer, date, and reasons in each case. | X |  | Branch of Service (Army, Navy, Marine Corps, Coast Guard, etc.) | SERIAL NO. (if none, give grade or rating at time of separation)32. HAVE YOU EVER BEEN BARRED BY THE U. S. CIVIL SERVICE COMMISSION FROM TAKING EXAMINATION OR ACCEPTING CIVIL SERVICE APPOINTMENTS? If your answer is "Yes," give dates of and reasons for such debarment in Item 39. | X |  | 38. (A) IF YOU SERVED IN THE UNITED STATES MILITARY OR NAVAL SERVICE DURING PEACE TIME ONLY, DID YOU PARTICIPATE IN A CAMPAIGN OR EXPEDITION AND RECEIVE A CAMPAIGN BADGE OR SERVICE RIBBON? | X |    (B) ARE YOU A DISABLED VETERAN? If so, and you have not listed your disability in answer to Item 33, explain in Item 39 below. |  | X33. HAVE YOU ANY PHYSICAL HANDICAP, DISEASE, OR OTHER DISABILITY WHICH SHOULD BE CONSIDERED IN ASSIGNING YOU TO WORK? If your answer is "Yes," give complete details in Item 39 so that consideration can be given to your physical fitness for the job. | X |  | (C) ARE YOU A VETERAN'S WIDOW WHO HAS NOT REMARRIED? |  | X34. 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? If your answer is "Yes," give complete details in Item 39 | X |  | (D) ARE YOU THE WIFE OF A VETERAN WHO HAS A SERVICE CONNECTED DISABILITY WHICH DISQUALIFIES HIM FOR CIVIL SERVICE EMPLOYMENT? |  | XTHIS 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 19..| ITEM NO                           | Agency:         | Title: || --------------------------------- | --------------- | ------ || 37a Navy: July, 1940 - Oct., 1942 | 110 97532       |        || Army: Oct., 1943 – Feb., 1946     | Serial O-507241 |        |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 OF APPLICANT(Sign your name in INK (one name, initial or initials, and surname) If female, write your own given name as "Mrs. Mary L. Doe")