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# REFERENCES List three 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. Do not repeat names of supervisors listed under Item 15 (EXPERIENCE).| FILL NAME             | PRESENT COMPLETE ADDRESS (Give complete current address, including street and number) | BUSINESS OR OCCUPATION || --------------------- | ------------------------------------------------------------------------------------- | ---------------------- || Westmore Willcox, Jr. | 60 William St., New York City                                                         | Investments            || Robert G. North       | 5947 Freuonia Drive, Hollywood, Cal.                                                  | Textiles               || Maj. J.K. Singlat     | "L" Bldg., Washington, D.C.                                                           | U.S. Army              |INDICATE "YES" OR "NO" ANSWER BY PLACING "X" IN PROPER COLUMN25 MAY INQUIRY BE MADE OF YOUR PRESENT EMPLOYER REGARDING YOUR CHARACTER QUALIFICATIONS, ETC?26 ARE YOU A CITIZEN OF OR DO YOU OWE ALLEGIANCE TO THE UNITED STATES?INDICATE "YES" OR "NO" ANSWER BY PLACING "X" IN PROPER COLUMN| YES | NO  |                                                                                      || --- | --- | ------------------------------------------------------------------------------------ ||     | X   | 35. ARE YOU AN OFFICIAL OR EMPLOYEE OF ANY STATE TERRITORY, COUNTY, OR MUNICIPALITY? ||     | X   |                                                                                      |If your answer is "Yes," give details in Item 39.27 ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF THE COMMUNIST PARTY?28 ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF A FASCIST ORGANIZATION?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 WHICH SEEKS TO ALTER THE FORM OF GOVERNMENT OF THE UNITED STATES BY UNCONSTITUTIONAL MEANS?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 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 OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL, QUASI-CRIMINAL, OR CIVIL CASE? IF EVER FINED OR IMPRISONED OR MADE TO DEPOSIT BAIL FOR COLLATERAL FOR THE VIOLATION OF ANY LAW, POLICE REGULATION OR ORDINANCE (EXCEPT TRAFFIC VIOLATIONS FOR WHICH A FINE OF FORFEITURE OF LESS 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 (5) other disposition of the case. If appointed, your fingerprints will be taken.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 reason in each case.32 HAVE YOU EVER BEEN BARRED BY THE U.S. CIVIL SERVICE COMMISSION FROM TAKING EXAMINATIONS OR ACCEPTING CIVIL SERVICE APPOINTMENT?If your answer is "Yes," give date of and reasons for such debarment in Item 39.33 HAVE YOU ANY PHYSICAL HANDICAP, DISEASE OR OTHER DISABILITY WHICH SHOULD BE CONSIDERED IN ASSIGNING YOU TO CERTAIN WORK?If your answer is "Yes," give complete details in Item 39 so that consideration can be given to your physical fitness for the work.| YES | NO  |                                                                                                                                                                                                                    || --- | --- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ || X   |     | 36. DOES THE UNITED STATES GOVERNMENT EMPLOY IN A CIVILIAN CAPACITY ANY RELATIVE (FATHER, MOTHER, HUSBAND, WIFE, SON OR DAUGHTER BY BLOOD OR MARRIAGE) WITH WHOM YOU LIVE OR HAVE LIVED WITHIN THE PAST 24 MONTHS? || X   |     |                                                                                                                                                                                                                    |If your answer is "Yes," show in Item 39 for 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 arrow, a DISABLED VETERAN, or as the WIFE OF A DISABLED VETERAN, or as the WIDOW OF A WAR OR CAMPAIGN VETERAN, attach Veteran Preference Claim, C&C Form 14, together with proof upon which based.B. If you are a WAR-TIME VETERAN claiming disability preference, you should NOT submit your discharge with this application. Preference will be tentatively credited to you and if approved you will be required to submit to the appointing officer prior to entry on duty certified evidence of separation from active service in the armed forces of the United States in time of war.| YES | NO  |                                                                                                                                                      || --- | --- | ---------------------------------------------------------------------------------------------------------------------------------------------------- || X   |     | 37 (A) WERE YOU EVER IN THE UNITED STATES MILITARY OR NAVAL SERVICE DURING TIME OF WAR?                                                              || X   |     |                                                                                                                                                      || 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   |     |                                                                                                                                                      || X   |     | (C) WAS SERVICE PERFORMED ON AN ACTIVE FULL-TIME BASIS, WITH FULL MILITARY PAY AND ALLOWANCES?                                                       |DATE OF ENTRY OR ENTRIES INTO SERVICE DATE OF SEPARATION OR SEPARATIONSSee belowBRANCH OF SERVICE (Army, Navy, Marine Corps, Coast Guard, etc.) (if none, give grade or rating at time of separation)See below| YES | NO  |                                                                                                                                                                                            || --- | --- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ || X   |     | 38 (A) 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? || X   |     |                                                                                                                                                                                            || X   |     | (B) ARE YOU A DISABLED VETERAN?                                                                                                                                                            || X   |     |                                                                                                                                                                                            |If so, and you have not listed your disability in answer to Item 33, explain in Item 39 below.| X |  | (C) ARE YOU A VETERAN'S WIDOW WHO HAS NOT REMARRIED? || X |  | (D) ARE YOU THE WIFE OF A VETERAN WITH A SERVICE CONNECTED DISABILITY WHICH DISQUALIFIES HIM FOR CIVIL SERVICE APPOINTMENT? |THIS SPACE FOR USE OF APPOINTING OFFICER ONLYTHIS SPACE FOR DETAILED ANSWERS TO QUESTIONS (Indicate item numbers to which answers apply)37A Navy: July, 1940 - Oct. 1942 File 9732.37A Army: Oct. 1946 - Feb. 1946 Serial 0-87211The information contained in the answers to Question 17 above has been verified by comparison with the discharge certificate ca... 19....Agency: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. Give your present title. Mr., Mrs., or Miss and if married)